Skip to main content

Full text of "Physician and Surgeon"

See other formats


Google 



This is a digital copy of a book that was preserved for generations on library shelves before it was carefully scanned by Google as part of a project 

to make the world's books discoverable online. 

It has survived long enough for the copyright to expire and the book to enter the public domain. A public domain book is one that was never subject 

to copyright or whose legal copyright term has expired. Whether a book is in the public domain may vary country to country. Public domain books 

are our gateways to the past, representing a wealth of history, culture and knowledge that's often difficult to discover. 

Marks, notations and other maiginalia present in the original volume will appear in this file - a reminder of this book's long journey from the 

publisher to a library and finally to you. 

Usage guidelines 

Google is proud to partner with libraries to digitize public domain materials and make them widely accessible. Public domain books belong to the 
public and we are merely their custodians. Nevertheless, this work is expensive, so in order to keep providing tliis resource, we liave taken steps to 
prevent abuse by commercial parties, including placing technical restrictions on automated querying. 
We also ask that you: 

+ Make non-commercial use of the files We designed Google Book Search for use by individuals, and we request that you use these files for 
personal, non-commercial purposes. 

+ Refrain fivm automated querying Do not send automated queries of any sort to Google's system: If you are conducting research on machine 
translation, optical character recognition or other areas where access to a large amount of text is helpful, please contact us. We encourage the 
use of public domain materials for these purposes and may be able to help. 

+ Maintain attributionTht GoogXt "watermark" you see on each file is essential for in forming people about this project and helping them find 
additional materials through Google Book Search. Please do not remove it. 

+ Keep it legal Whatever your use, remember that you are responsible for ensuring that what you are doing is legal. Do not assume that just 
because we believe a book is in the public domain for users in the United States, that the work is also in the public domain for users in other 
countries. Whether a book is still in copyright varies from country to country, and we can't offer guidance on whether any specific use of 
any specific book is allowed. Please do not assume that a book's appearance in Google Book Search means it can be used in any manner 
anywhere in the world. Copyright infringement liabili^ can be quite severe. 

About Google Book Search 

Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers 
discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web 

at |http: //books .google .com/I 



. No. 

Boston 

Medical Library 

Association, 

19 BOYLSTON PLACE 




No. 

Boston 

Medical Library 

Association, 

19 BOYLSTON PLACE 




I 



•t-^ ^^ 



THE 



PHYSICM AID SFRGEOI 



A MONTHLY MAGAZINE, 



DEVOTED TO MEDICAL A5D SURGICAL SCMCK 



GEORGE A. HENDRICKS, M. D., 




VOLUME m 



AM AB60B, MICHIGAN: 
JOHN WILLIAM KEATING, 

PUBLIBHBR AND PROFBISTOK. 



N 






CONTRIBUTOES. 



GEORGE A. HENDRICKS, M. D., 

EDITOR. 



H. B. BAKER, M. D., 6 57 58 149 199 202 245 349 399 451 494 548 

J. A. BOBB, 1161106 303 452 

J. W. BOSMAN, M. D., . . . , . , 269 

CH. BOUCHARD, M. D., 649 

R. G. CAVANA6U, 64 

E. P. CHRISTIAN. M. D 268 

G. H. CLEVELAND, M. D„ 52 

R. P. COMFORT, M. D., 6 

A, F. DIGHT, M. D., 100 

W. T. DODGE, M. D 97 

E. C. PISH. M. D 243 

CONRAD GEORGE, M. D., . . . 203 289 359 404 481 
ANNA M. GOEBEL, M. D., 248 

F. GOODWIN, M. D., .460 

P. J. GRONER, M. D., 342 

W. F. HAKE. M. D., 1 

J. W. HANDY, M. D 193 339 

HARRIET L. HARRINGTON, M. D., . . .49 629 

WALTER HAY, M. D.. LL. D., 501 

C. M. HAYNES, M. D., 489 

A. J. HOSMER, M. D., 152 

A. W. HURD. M. D., 55 196 364 

A. E. JENKINS 149 

ALFRED LA VERTY, M. D 145 

C. J. LUNDY, A. M., M. D . 55 385 

DONALD MACLEAN, M. D., 13 65 152 206 254 433 

JOHN MADDEN, M. D., ..".... 547 

W. P. MUNN 206 254 

H. C. PADDOCK, M. D . 242 

MARGARET E. PEGELSEN, M. D., .... 499 

J. E. PILCHER. M. D., 541 

A. B. PRESCOTT, M. D., 536 

J. H. RAND, M. D 156 

D. E. ROBINSON, M. D., 347 

W.B. SEXTON 13109 

D. G. SHARPE, M. D 450 

O. C. STRICKLER. M. D., 108 

T. J. SULLIVAN, M. D., .... 337394503552 
P. W. VINCENT. M. D 301 

E. J. WHITEHEAD, A. B., . 7 103161205 246 251 

C. M. WOODWARD, M. D., 445 

P. B. WOOLSEY, M. D., 99 






« 






INDEX TO VOIUME VH. 



PAOB 

Abdominal section in hospital 

theatre, 212 

Abdominal surgery, an ab- 
stract of clinical lecture, 13 
Abdominal surnrery, case and 

clinical remarks, 206 

Abortion, the use and abuse 

of tampons, 424 

Abortion, treatment of habit- 
ual, 384-478 
Abscess and necrosis follow- 
ing dislocation of shoulder, 108 
Abscess of the breast, 258 
Abscess, chronic, of breast, 259 
AbscesM, acute, 287 
Abscess in region of the knee, 501 
Actinomvcrosis, a contribution 

to the kuDwledge in man, 149 
Albuminuria, with a case «of 

uterine hydatids, , 241 

Albuminuria in diphtheria 

and scarlet fever, 283 

Alcoholic liquors, the abuse of, 233 
Alcoholic* sponge bath in ty- 
phoid fever, 313 
Alkaloids of quebracho, the 

effects of the, 232 

Amenorrhcea, treatment by 

permaganate of potash, 190 
Amenorrhoaa, permanganate 

of potash in, 334 

Amceba, giant in chronic en- 
teritis of the EsryptianB, 452 
Amputation of finger for en- 

chondroma, 65 

Amputation, subperiosteal 

method of, 164 

Amyl, nitrite of in intermittent 

fever, 384 

Ansesthetics in European hos- 

pitalP, 112 

Ansesthetic in labor, the 

bromide of ethyl as an, 263 
Ansemia, idiopathic of Ad- 
dison, 281 
Ansemia. reduced iron in treat- 
ment of, 572 
Ankle-joint,Syme's operation 

in railroad injury 109 

Antipyrin, 186-315 

Ant i pyrin in typhoid fever, 333 
Antipyretic action of the 

alkaloids of quebracho, 232 
Antineptic preparation of silk, 219 
Aniiseptics, the xuo9t pQW^r- 
ful, ^ ?38 



PAOB 

Antiseptic method in erysipe- 
las, 505 
Antiseptic, aseptol, the new, 184 
Appendix vermiformis, 

treatment of perforation of, 135 
Aqua crensoti, 522 

Arsenic, Fowler's solution of 
in treatment of neuralgia of 
the stomach, 93 

Arsenic, bromide of for pim- 
ples, 383 
Ascii:es, 450 
Ascites, early puncture in, 369 
Aseptol, the new antiseptic. 184 
Association, meeting of tne 
American for the advance- 
ment of science, 355 
Ataxia, new symptom of lo- 
comotor, 191 
Atresia of the vagTna and 
division of the urethra and 
base of the bladder, 394 
Bacteriology, recent progress 

in, 232 

Battery, improved American 

pocket, 77 

Belladonna in strangulated 

hernia, 93 

Belladonna and iodide of po- 
tasBium, the combined 
administration of, 335 

Belledonna in cholera infan- 
tum, 384 
Blackwell's Island hospital, 

obstetric practice in, 336 

Blood, the presence, source, 
and significance of sugar in* 
the, 134 

Brain, tumor of, removed, 77 
Brain complications in case of 

typhoid fever, 529 

Breathing through the mouth, 169 
Breast, abstract of remarks on 

cancer of the, 254 

Breast, cancer of the, 258 

Brea»t, abscess of the, 258 

Breast, chronic ab8ce^s of the, 259 
Breast, scirrhus of the right, 260 
Breast, cancer of, 504 

Bright's disease of malarial 

origin, 117 

Bromide of ethvl as an an- 

SBdthetic in labor, 263 

Brom ides to prevent iodism, 380 
Buckwheat flour in diabetes, 336 
Bullet-wound in the stomach, 248 



) 



INDEX TO VOLUME VII. 



' V 



PAOB 

Cfesarian operation perform- 
ed by the patient, 221 
Galcali, biliary, 286 
Calomel in diphtheria, 120 
Calomel, the reKolving action 
in very minute doses in the 
treatment pf pneumonia, 237 
Cancer of the breast, abstract 

of remarks on, 254 

Cancer of the breast, 258, 504 
Cancer, extirpation of the 

uterus for, ' 166 

Cannabis Indica as a local 

anaesthetic, 335 

Cannabis Indica in the opium 

habit, 526 

Cantharid^s, chloral hydrate 

a substitute as a vesicant, 121 
Capillary drainage in the 

treatment of wounds, 118 

Carbolized water to prevent 

shock in lithoplaxy, 121 

Carbolic acid in dyspepsia, 865 
Case showing what may be 
accomplished under disad- 
vantageous circumstances, 489 
Catheters, lubricant for, 334 

Catheters, method of clean- 
ing, 46 
Cavities, operative opening of 

pnlmonai^y, 43 

Cerebral hemiphegia, infan- 
tile, 513 
Cerebrum, general atrophy of 

gray matter of, 481 

Cerebellum, abscess and gran- 
ular degeneration of, 481 
Chancre of lower eyelid pro- 
duced by inoculation, 116 
Chancre, rapid cure of the 

simple, 182 

Chancre, abortive treatment 

of the soft, 173 

Cheese- poison, tyrotoxioon, 347 
Children, night-terrors in, 188 
Childbirth, a case with con- 
strictions in the (true) pel- 
vis of a cyst of the right 
ovary, complicated by hy- 
drosalpinx and tumor of 
the left ovary, 10 

Chilblain, a mixture for, 45 

Children, cases illustrating 

hvsterical affections in, 61 

Children, summer complaint 

of, 380 

Chloroform and croton oil 
for tape-worm, 36 



PAGl 

Chloroform, death of a physi- 
cian from, 29 
Cblorobydrate of kairine, 233 
Chloral hydrate for night 

sweats, 455 

Chloral hydrate substituted . 
as a vesicant for canthari- 
dies, 121 

Chordee and Gonorrhoea^ 240 
Cholera, treatment of Asiatic, 246 
Cholera infantum mixture, 527 
Cholera infantum, belladonna 

in, V 384 

Cholera infantum, morphia 

in. 478 

Cholera, injection of tannic 

acid for, 454 

Chorea, 501 

Chromic acid in affections of 

the tongue, 119 

Chronic abscess of breast, 259 
Cinnamon bark in toothache, 47 
Circulation, a new theory of 

foetal, 121 

Clert^ymen versus snails, 457 

Clinical lecture on -abdom- 
inal surgery," an abstract of, 13 
Clothing, disinfectants for, 192 
Cottaine in treatment of hay- 
fever, 573 
Cocaine, history and use, 20 
Cocaine, the physiological ac- 
tion of, 286 
Cocaine in treatment of in- 
flamed nipples, 460 
Cocaine in chronic pharyngi- 
tis, 526 
Cocaine, the uses of, 528 
Cold, the use of in labor, 144 
- Color associated with sense 
of taste and smell and form 
with sound, 252 
Committees of the Michigan 

State Medical Society, 358 

Congenital absence of vagina 

and uterus, 547 

Conjunctivitis, treatment of 

purulent, 555 

Constipation, water in ha^ 

bituHl, 6 

Constipation in children, oat- 
meal for, 477 
Contusions, decoctions of va- 
lerian in the treatment of, 239 
Corns, treatment of, 384 
Corpulence, 571 
Corrosive sublimate in ure- 
thritis, 93 



VI 



INDEX TO VOLUBiE VH. 



PAGE 

Corrosive sablimate treat- 
ment of woundfi produce 
enteritis, 250 

Coryza, an inhalation for, 313 
Correction in muriate of co- 
caine, 55 
Cough, whooping, 236 
Cough, the nasal, 250 
Croup, tracheotomy in, 455 
Croup and diphtheria not 

identical diseases, 28 

Cozitus, examination per rec- 
tum in, 186 
Creosote, solidified, 46 
Credit not given, 68 
Croton oil and chloroform for 

tape- worm, 36 

Cutaneous administration of 

salicylic acid, 527 

Ovstitis, a case of acute, 339 

Cyst of the right ovary with 
constriction of the (true) 
pelvis in a case of child- 
birth, complicated by hy- 
drosalpinx and tumor of 
the left ovary, 10 

Diphtheria and croup not 

identical diseases, 28 

Diphtheria not a sewer dis- 
ease, 75 
Diphtheria, calomel in, 120 
Dipsomaniaand drunkenness, 234 
Disinfection and disinfec- 
tants, 273 
Disinfectants and disinfec- 
tion, 273 
Disinfectants, standard, 191 
Disinfet^tants for clothing, 192 
Dislocation of shoulder fol- 
lowed by absces and ne- 
crosis, 108 
Diseases of children, the 
value of single symptoms in 
the treatment of, 68 
Discoveries, effects of new, 73 
Distomtim haematobium, the 
presence of eggs in abdom- 
inal organs, 303 
Douche in obstetric practice, 327 
Drainage, capillary in the 

treatment of wounds, 118 

Darwinian, the theory, 368 

Death, caused by entrance 
of air into the veins of the 
uterus, 8 

Delerium tremens, treatment 

of, 173 

Dentistry in Japan, 167 



PAGB 

Diabetes mellitis, 155 

Diabetes mellitis cured by 

drinkine vinegar, * 301 

Diabetes, buckwheat flour in, 336 
Diabetes insipidus, ergot in, 93 
Dietetic treatment of dyspep- 
sia, 216 
Digestion of meats and fats, 41 
Digitalis, the physiological 

action of, 71 

Digestion, some practical 

points in, 465 

Dilatation of the stomach in 

infants, 151 

Diphtheria and scarlet fever, 

albuminuria of, 283 

Diphtheria, chloral treatment 

of, 239 

Diphtheria, the spread of, 40 

Dressing for ulcers of the leg, 44 
Drinking, moderate and tee- 
total! sm, the Lancet on, 37 
Drunkenness and dipsomania, 234 
Dnpuy trends contraction, rap- 
id cure by excision, 308 
Dyspepsia, dietetic treatment 

of, 216 

Dyspepsia, carbolic acid in, 365 
Dysentery, ergot in children, 327 
Dysentery, acute, 336 

Dysentery, turpentine in treat- 
ment of, 383 
Earth, mineral, 47 
Eclampsia, the treatment of 

puerperal, 103 

Eclampsia, puerperal, ' , 450 

Education, moderation in, 33 
Electrolysis in treatment of 

stricture of urethra, 1 

Electricity in chronic rheu- 
matism of the joints, 150 
Enchondroma of finger, am- 
putation of, 65 
Enteritis from treatment of 
wounds with corrosive sub- 
limate, 250 
Entero-colitis, 369 
Enteritis, giant amoebae in 

chronic of the Egyptians, 452 
Epilepsy, treatment of, 181 

Ergot, a new extract of, 133 

Ergot in typhoid fever, ^ 151 
Ergot for dysentery in child- 
ren, 334 
Ergot in diabetes insipidus, 93 
Erysipelas, pilocarpine in 

abortion of facial, 121 

Erysipelas, jarborandi in, 143 



tXfDSX TO VOLUHB VII. 



«* 

vu 



PAGI 

Erysipelas, 145 

Erysipelas and the antiseptic 

method, 505 

Erysipelas and puerperal fe- 
ver, 515 
Escharotic, painless, 45 
Ether, hypodermic injections 

of, causing paralysis, 144 

Ethyl, the oromide of as an 

anseathetic in lahor, 263 

Excesses, effect upon the 

mind, 225 

Feecal fistula at the scrotum 

of a child four months old, 11 
Fallopian tube, laparotomy 

for tumors of the, 9 

Fats and meats, digestion of, 41 
Feet, lotion for foetid perspi- 
ration of the, 335 
Fever, treatment of hay, 285 
Fever, puerperal in a male, 143 
Fever, iodine in the treat- 
ment oif intermittent, 383 
Finger, enchondroma and 

amputation of. .65 

Fistula, fsecal at the scrotum 

of a child ibur months old, 11 
Foetal circulation, a new the- 
ory for, 121 
Fracture of tibia, ulcer re- 
sulting from, skin grafting, 64 
Fracture, a case of simple 
comminuted of right tibia 
and fibula, 445 
Fracture, oblique of humerus, 
with special reference to 
treatment of fractures of 
the humerus, 445 
Franco Pierre, his times and 

his surgical practice, 541 

Glands, nitrate of silver and 
vaseline treatment in stru- 
mous, 94 
Glycerine as a tsenicide, 383 
Glycerineum albuminis, 509 
Goitre, the treatment of, 118 
Goitre, tteatmeni of, by in- 
jections of iodine, 215 
Gonorrhoea and chordee, 240 
Gonorrhoea, an urethral oint- 
ment for, 285 
Gynaecology, massage in, 129 
Hair, to prevent falling out 

of the, 883 

Hair tonic, 177 

Hay-fever, treatment of, 285 

Hay-fever, cocaine in treat- 
ment of, 573 



PAoa 

Hamamelis virginica, thera- 
peutic uses of, 183 

Haemostatic pill, 286 ' 

Health in Michifran, 

5-57-102-148-202-245.399-451 498 548 

Heart, iodoform in the treat- 
ment of organic diseases of, 

190-239 

Heart-sound, the production 
of the second, 41 

Health, report of the Mich- 
igan State Board, 58 

Headache, to abort sick, 335 

Hsemorrhoids. treatment of 
strangulated, ' 423 

Hsemorrhoidal tumors, oleate 
of morphia in, 425 

Hereditv of disease, a family 
record showing the, 49. 

Hernia, belladonna in stran- 
gulated, 93 

Hernia, radical cure of, 286 

Homoeopathic farming, 48 

Homoeopathic, high potency 
of, 93 

Hydrosalpinx and tumor of 
the left ovary, complica- 
tion by, in a case of child- 
birth, with constriction in 
the (true) pelvis of a cyst 
of the right ovary, 10 

Hydrastus, the physiological 
efi'ects and therapeutical 
U8es of the, 160 

Hydrocele, the treatment of, 337 

Hydrocele of the neck, a case, 243 

Hydatids, a ca^e of uterine 
with albuminuria, * 241 

Hypodermic injections of eth- 
er causing paralysis, 144 

Hysterical afff'ctions in chil- 
dren^ cases illustrating, 61 

Incontinence of urine in 
children, 186 

Index Medicus, the, 159 

Infants, the management of 
new-born, 235 

Infantile cerebral hemiplegia, 513 

Infantile paralysis, treatment 
of, 113 

Inflammation, a new explana- 
tion of the process of, 89 

Injections of iodine in treat- 
ment of goitre, 215 

Insanity, opium in the treat- 
ment of, 378 

Insanity, nitro - glycerine in 
the treatment of, 509 



Tin 



INDEX TO VOLTTMB VII. 



PAGl 

Intestinal obstniction, treat- 
ment of, 116 
Intestine, resection of, 264 
Intestinal obstruction in a 

child, 374 

Inunctions, effects of general 

on temperature, 509 

Iodoform, a test for the purity 

of, 48 

Iodoform in orgaine diseases 

of the heart, 190-239 

Iodoform, the purity of, 237 

Iodine injections in treat- 
' ment of goitre, 215 

Iodine in the treatment of 

intermittent fever, 383 

Iodide of potassium and bel- 
ladonna, the combined ad- 
ministration of, 335 
Iodi.*<m prevented by the bro- 
mides, 380 
Iritis, its relation to the rheu- 
matic diathesis and its 
treatment, 385 
Iron, reduced in the treats 

ment of ansemia, 572 

Japan, dentistry in, 167 

Jarborandi in erysipelas, 143 

Jequirity a dangerous drug, 121 
Joints, electricity in chronic 

rheumatism of the, 150 

Kairine,thechlorohydrateof, 233 
Kidney, misplaced, 143 

Labor, on the third stage of, 140 
Labor, the use of cold in, 144 
Labor, causation of, , 170 

Labor, introduction of pre- 
mature, 382 
Lactic acid as a destructive 

agent in pathogenic tissue, 203 
Lactation and weaning, the 

duration of, 332 

Laparotomy for tumors of the 

Fallopian tube, 9 

Laryngeal diseases, the rela- 
tion to pulmonary diseases, 92 
Laryngitis, the treatment of 

acute, 267 

Leg, dressing for ulcers of, 44 
Legislation, medical, 67 

Leprosy, Asiatic, 100 

Leprosy in China, 516 

Leucorrhoea, injection for va- 
ginal. ' 335 
Lingual nerve, stretching of 

the for neuralgia, 265 

Liquors, the abuse of alco- 
holic, 233 



PAOA 

Lithoplaxy, carbplized water 
to prevent shock in, 121 

London, medical study in, 53 

Lumbermen of Northern 
Michigan, the unsanitary 
condition of the, 62 

Malarial origin of Bright's dis- 
ease, 117 

Mammse, painful in young 
girls. 479 

Management of new born in- 
fants, 235 

Manganese as a remedy in 
menstrual troubles, 122 

Massage in treatment of 
sprains, 44 

Massage in gynsecolo^, 129 

Massage, its antiquity and 
uses, 177 

Maternity, early, 478 

Meals and fats, digestion, of, 41 

Medical study in London, 53 

Medical legislation, 67 

Medical women in India and 
Africa, 213 

Medical profession, duty of the 
State towards, 289 

Medical society, meeting of 
Michigan State. 299 

Medicines, should proprietary 
be required to give an ac- 
count of contents, 536 

Medico-legal matters, some 
recent decisions on, 138 

Menstrual troubles, manga- 
nese as a remedy in, 122 

Menstruation, precocious, 220 

Mercury, three pounds and 
three drachms of carried in 
intestinal canal for thirteen 
days, 39 

Mercury, new mode of obtain- 
ing rapidly the constitu- 
tional effects of, 40 

Mercury in syhpilis, 368 

Microbe, meaning of word, 76 

Michigan State Boatd of 
Health, 58-199-494 

Micrococci of pneumonia, as- 
sociated with scarlet fever 
and diphtheria, 335 

Mind, the effect of excesses 
npon the, 225 

Mind and neryous system, the 
hygiene of, 563 

Morphia in cholera infantum, 478 

Mouth, breathing through 
the, 169 



INDEX TO VOLUME VIL 



IX 



- 1 



PAGE 

Mumps, complisations ob- 
served in various organs of 
sense during the course of, 606 

Muriate of cocaine, a correc- 
tion, 55 

Mustard pponpe, 508 

I4aphth»1ine in treatment of 
typhoid fever, 266 

Naphthaline in acute intes- 
tinal catarrh of children, 367 

Nasal polypi, the treatment 
of, 48 

Nasal nerve, stretching of the 
external, 63 

Neck, a case of hygromic cyst 
of removal by operation, 106 

Neck, a case of hydrocele of, 243 

Neck, five cases of tumor of, 652 

Necrosis and abcess followiug 
dislocation of shoulder, 180 

Nephritis, a case of acute 
tubular complicated with 
pneumonia, 97 

Nerve, exi ei nal nasal, stretch- 
ing of the, 63 

Nerve centers of the uterus, 106 

Nerve counterfeits of uterine 
diseases, 137 

Nerve stretching, 618 

Nervous t-ystem and mind, the 
hygiene of 563 

Neuralgia of stomach. Fow- 
ler's solution in treatment 
of, 93 

Neuralgia, stretching of the 
lingual nerve for, 265 

New-born infants, the man- 
agement of, 235 

Night-sweats, chloral hydrate 
in, 455 

Nipples, cocaine in treatment 
of inflamed, 460 

Noses, help for red, 94 

Observations upon the mutual 
relations of the medical 
profession and the state, 433 

Obstetrical practice, the 
douche in, 327 

Obhtetrical practice in Black- 
well's Island hospital, 366 

Obstruction, treatment of in- 
testinal, 116 

Opium in the treatment of 
insanity, 378 

Opium habit, Cannabis Indica 
in the, 626 

Oranges stimulate the secre- 
tion of milk, 313 



PAGE 

Osmic acid, hypodermic use of, 526 

Osific union in the aged, 193 

Ovarian cysts, the relation of 
to urinary organs, with the 
functional derangetnen ts 
and diiliculties in opera- 
tions that result from it, 7 

Ovarian pains, treatment of 
by electricity, 478 

Ovariotomy, the early per- 
formance of, 42 

Ovariotomy in a child twenty- 
months old, 63 

Ovary, case of disease of the 
right, 198 

Oxygen and ozone, the ther- 
a|>eutio effect of, 189 

Ozone and oxygen, the ther- 
apeutic effeci of, 189 

Painless escharotic, 45 

Paralysis following hypoder- 
mic injections of ether, 144 

Paralysis, treatment of infan- 
tile, 113 

Pelletierine in treatment of 
tape- worm, 238 

Peppermint, oil of in burns, 142 

Peptonized, milk diet, 523 

Perforition of appendix ver- 
miformis, treatment of, .135 

Perineum, the protection of 
the, 499 

Perineum, care of the during 
labor, 656 

Pertussis, treatment of, 508 

Pharmaceutical congress, the 
international, 368 

Pharyngitis, cocaine in 
chronic, 526 

Phenomena of scarlet- fever, 
the treatment of the initial 
by the sulphate of quinine, 92 

Phosphorus in rachitis, 150 

Phosphorus, the administra- 
tion of. 172 

Piles, 479 

Pilocarpine, muriate in abor- 
tion of erysipelas, 121 

Pilocarpine, local sweating by, 381 

Pimples, bromide of arsenic 
for, 383 

Pityriasis rubra, salicylic acid 
in the treatment of, 99 

Plar'enta, the premature de- 
tachment the cause of still- 
birth, 236 

Pneumonia, care in convales- 
cence of, 114 



INDEX TO VOLUME VII. 



PAGB 

Pneumonia, the reaolvini; ac- 
tion of very minute doses 
of calomel in the treatment 
of, 236 

Pneumonectomy, 231 

Polypi, the treatment of 

nasal, 38^8 

Potassium permanganate, its 

use and action, 81 

Potassium permanganate, in 
. amenorrboea, 100-^34 

Potassium permanganate pills, 

an excipient for, 384 

Potency, homeopathy, high, 93 
Premature labor, 333 

Pruritis viilvse, 383 

Publications, New : 
Anatomy (Holden), 221 

BacteriH, tlie technology of 

investigation (Do I ley), 600 
Bandaging, a Manual of 

(Leonard), 77 

Berlin as a Medical Centre, 317 
Day-book, physician's pock- 
et, (Leonard), 659 
Cholera (Palmer). 431 
Drugs and Meaicines of 

North America (Lloyds), 78 
Ear (Biirneti), 430 

Eye, Clinical studies on the 

Diseases of (Aidt), 316 

Fractures and Dislocations, 
a Practical Treatise on 
Hamilion) 79 

Histology, The Student's 

Manual of (Stowell), 174 

History of the University 

of Michigan (Farrand), 223 
Materia Medica and Thera- 
peutics (Bruce), 78 
Micro-Chemistry of Poisons 

(Worm ley), 268 

Pharmaco^KBia for Treatment 
of Diseases of Pharynx 
and Larynx and Nasal 
Passages (Lefferts), 460 

Pharynx, Larynx, Trachea, 
(Esophagus, Nose and 
Naso-Pharynx (Macken- 
sie), 30 

Preventive Medicine (Rich- 
ardson), 427 
Pysiology (Foster), 512 
Practice of Medicine, A Sys- 
tem of by American Au- 
thors ; Pepper), 123 
Publishing, One Hundred 
Years of, 270 



Publications, Nbw: 
Qiiiz-Compends, 509 

Sanitary Suggestions on 
How to Disinfect our 
Homes, 316 

Skin Diseases, Hand-Book 
of the Diagnosis and 
Treatment of (Van Har- 
lengen), 430 

Surgery, The Science and 

Art of (EfichHen), 126 

The London Medical Stu- 
dent (Erichsen), 174 
The Oleates (Shoemaker). 429 
The Year-Book of Treat- 
ment for 1884, 222 
Treatise on Practical Chem- 
istry and Qualitative Inor- 
ganic Analyses, 521 
Urinary and Renal Derange- 
ments and Calculous Dis- 
orders, 510 
Puerperal eclampsia, the treat- 
ment of, 103 
Puerperal fever in a male, ^ 143 
Pulmonary affections, beech 

creosote in, 239 

Pulmonary consumption,rule8 
for the hygienic treatment 
of, 321 

Pulmonary cavities, the oper- 
ative opening of, 43 
Pulmonary phthi<iii4, paraciti* 

cides in the treatment of, 520 
Pulmonary diseases, the rela- 
tion to laryngeal, 92 
Pylorus, curdled milk lodged 

in the, 368 

QuebrAcho, antipyretic action 

of the alkaloids of, 232 

Queries, 72 

Quinine, to disguise, 526 

Quinine, sulphate in the treat- 
ment of the initial pheno- 
mena of scarlet fever, 92 
Quinine producing contrac- 
tions of uterus, 220 
Rachitis, phosphorus in, 150 
Railroad injury, Syme's oper- 
ation of ankle-joint for, 109 
Rectum examination, per in 

coxitus, 186 

Rectum, imperforate, 347 

Resection of the Intestine, 264 
Rhegoline, 172 

Rheumatism, electricity in 

chronic of joints, 150 

Ringworm, the treatment of, 91 



INDEX TO VOLUME VII. 



XI 



PAOB 

Hingworm of the scalp, the 
treatment of, 310 

finpture of the diaphrn^in 
with lodgment of left kid- 
ney, spleen, and portion of 
stomach within the thorax, 
cauhed by injury, 364 

Salicylic paper, 260 

Salicylic acid, hypodermic use 
of, 527 

Salicylic acid in treatment 
of pityriasis rnb^, 90 

Salicylate of soda, the action 
of upon the uterus, 142 

Salines, nauseous in ice wa- 
ter, 76 

Sanitary convention at Ypei- 
lanti, 849 

Sanitary work, good health 
results from, 402 

Santonine mt»8t efficient in 
emulsion with oil, 29 

Scalp, treatment of ringworm 
of the, 310 

Scarlet fever and diphtheria, 
albuminuria of, 283 

Scarlet fever, treatment of the 
initial phenomena of by the 
sulphate of quinine, 92 

Scarlatina, means of diagnosis 
of. 421 

Sciatica, cold in, 334 

Scirfhiis of t he right breast, 260 

Shoulder diHlo<!ati on followed 
by abscess and necrosis, 108 

Silk, the antiseptic prepara- 
tion of, 219 

Bilk, aseptic for sutures, 143 

Silver, nitrate of in spinal irri- 
tation, 47 

Single symptoms, the valne of 
certain in treatment of dis- 
easeH of rhildren, 68 

Skin, absorbing power of the 
normal human, 253 

Skin-grafting on ulcer result- 
ing from fracture of tibia, 64 

Small-pox versus vaccina- 
tion, 458 

Smell and taste, the sense of 
associated with color, and 
sound with form, 252 

Snails versus clergymen, 457 

Society, state medical, 307, 158 

Soda, bicarbonaie in early 
stage of tonsilitio, 76 

Soda, the action of salicylate 
npon the uterus, 142 



PAOB 

Sound, the sense of associated 
with form, of smell and 
taste with color, 252 

Spermatorrhoea, pills for, 288 

Spinal cord, congestion of 155 
Spinal irritation, nitrate of 

silver in, 47 

Spleen, the function of the, 38 
Splenic murmur in inter- 
mittent fever, 480 
Sprains, massage in the treat- 
ment of, 44 
State medical society, 260 
Still-birth, premature detach- 
ment of the placenta a 
cause of, 236 
Still-birth, the causes of, 230 
Stomach, dilatation of. - 205 
S(oma<-h, dilatation or in in- 
fants, 151 
Stomach, bullet wound in the, 248 
Strangulated hernia, bella- 
donna in, 93 
Stretching of the external 

nasal nerve, 63 

Stricture of the urethra, the 

treatment by electrolysis, 1 
Sugar, the presence, source, 
and significance of in the 
blood, 134 

Summer complaints of child- 
ren, ' 380 
Surgery in Vienna, 196 
Surgery, case and clinical re- 
marks on abdominal, 206 
Suigery, abdominal, abstract 

of a clinical lecture on, 13 

Sutures, aseptic silk fof, 143 

SycosiM, an ointment for, 287 

Syphilis, in rrcury in, 368 

Tampon, the use and abuse of 

in abortion, 424 

T^nicide, glycerine as a, 383 

Tannic acid, injections of for 

children, 454 

Tape- worm, chloroform and 

croton oil for, 36 

Tape-worm, pel letierine in the 

treatment of, 238 

Temperature, a method of re- 
ducing, 143 
Tenotomy for a peculiar affec- 
tion of the tensor vagina 
femoris muscle, 152 
Tensor vagina femoris mus- 
cle, tenotomy for a peculiar 
affection of the, 152 
Terrors, night in clildren, 188 



Xll 



INDEX TO VOLUME VII. 



FAOE 

Testimonv, the value of ex- 
pert, ' 143 
Tetanufi, rational method of 

treatment, 367 

Thallin, a new antipyretic, 172 
Therapeutical advMncement, 212 
Therapeutics, practical, 286 

Therapeutics, modern, 167 

Threadworm, successful treat- 
ment of, 240 
Thyme, the therapeutic pro- 
perty of, 144 
Tongue, chromic acid in afflic- 
tions of the, 119 
Tonsilitis, bicarbonate of soda 

in e.<rly stage, 76 

TonFilitis aborted by an 

emetic, 46 

Toot hache, cinnamon bark in, 47 
Tooth, painlcFs extraction, 608 
Tracheotomy, non-pene- 
tration of the lining false 
membrane as a cause of 
failure in, 479 

Tracheotomy in croup, 455 

Tuberculosis in surgery, 422 

Tuberculosis, surgical experi- 
ence of, 404 
Tuberculosis, general, as a re- 

Hult of surgical operation, 119 
Tumors of the Fallopian tube, 

laparotomy for, 9 

Turpentine, the taste and 

smell mahked, 312 

Turpentine in the treatment 

of dysentery, 383 

Typhoid fever, ergot in, 151 

Typhoid ffever, anti pyrin in, 333 
Typhoid fever, alcohol sponge 

bath in, 313 

Typhoid fever, origin and 

prevention in, 314 

Typhoid fever, a case with 

brain complications. 529 

Tyrotoxicon, iheese-poison, 347 
Ulrers of the leg, dressing 

foTy 44 

Ulcer, resulting from fracture 

of the tibia, 64 

Ulcers of the leg, a French 

treatment for, 240 

"Ups and Downs" of an or- 
dinary practitioner, 342 
Ursemia, urea not a cause 

of, 116 

Ursemia, the therapeutics of, 549 
Vt^sl not a cause of ursemia, 115 



PAGK 

m 

Urethritis, corrosive subli- 
mate in, 93 

Urethra, the treatment of the 
stricture by electrolysis, I 

Urethra, the female, 185 

Urethra, ointment for gon- 
orrhoea, 285 

Urinary organs, the relation 
of the ovarian cysts with 
the functional derange- 
ments and difficulties in 
operations that result from 
it, 7 

Uterine diseases, nerve coun- 
terfeits of, 137 

Uterus, the action of salicyl- 
ate of boda upon, 142 

Uterus, extirpation for cancer ' 
of the, 166 

Uterus, the nerve centres of, 105 

Uterus and vagina, congenital 
absence of the, 547 

Vaccine commission, report 
of the general, 307 

Vaccination, Professor Tyn- 
dalTs theory for, 315 

Vaccination, multiple necro- 
sis following. 571 

Vaccination versus small-pox, 458 

Vagina, a case of atresia of 
and division of the urethra 
and base of bladder, 394 

Valerian, decoction of in the 
•treatment of strumous 
glands, 94 

Vegetarianism, 474 

Veins of the uterus, death 
caused by entrance of air 
into, 8 

Vermiform is, perforation of 
the appendix treatment, 135 

Vienna surgery, 196 

Vineifar, diabetes cured by 
drinking, 301 

Water in habitual constipa- 
tion, 6 

Weaning and lactation, the 
duration of, 332 

Whooping-cough, the treat- 
ment of, 480 

Whooping-cough, 236 

Women, treatment of run- 
down, 311 

Women, medical in India 
and Africa, 213 

Wounds, capillary drainage 
in the treatment of, 118 




PHYSICIAN MD SDE6E0I1 

A MONTHLY MAGAZINE, 
DEVOTED TO MEDICAL AND SURGICAL SCIENCE. 



Volume VII. JANUARY, 1885. Number I. 



ORIGINAL ARTICLES. 



THE TREATMENT OF STRICTURE OF THE URETHRA BY 

ELECTROLYSIS* 



BY W. F. HAKE, M. D., Qrand Kapids. Michigan. 



Mb. President: Electrolysis in the treatment of stricture of 
the urethra, is the subject of a brief paper which I read for 
your consideration. There is but little literature upon this 
method of treating stricture, and when it does receive mention, 
it is not spoken of as reliable or efficient. But before entering 
into its history the explanation of a few terms may be profita- 
ble. The term electrolysis means the decomposition or reduction 
of a compound substance by electricity. Any substance that 
can be directly decomposed by a current is an electrolyte. When 
a substance is chemically decomposed by a galvanic current it 
is dectrolyzed. Electrodes are the poles from which the current 
passes in and out of the body that is being decomposed. The 
anode refers to that part of the electrolyzed body, at which the 
current passes in, or that part which is in contact with the 
positive pole; the cathode that part where the current leaves the 
decomposing body, or that part which is in contact with the 
negative pole. Practically, however, anode is used synonymous 
with positive pole, and cathode with the negative pole of the 
battery. The elements of an electrolyte are termed ions. Those 
ions which appear at the anode are called anions^ and those 
which pass to tne cathode are termed cations. Formerly anions 

*Bead before the Academy of Medicine. 



2 StRIOTtJftB OF tHE URETItttA. 

were called electro-positive, and cations electro-negative, ele- 
ments. Some Oerman electro-therapeuticians still adhere to 
the latter terminology. An electrolyte must be in some degree 
a conductor of electricity. Substances vary greatly in their 
resistance to the decomposing power of the current. Certain 
conditions favor decomposition. Water must always be pres- 
ent, and the presence of certain salts increases the readiness of 
the electrolyte to decompose. Such bodies as are imperfect 
conductors, and the cohesive force of the particles not strong, 
and which contain easily decomposed salts and water, such as 
serum, blood, and different animal tissues, are good electrolytes. 
When such a substance is placed in the circuit of a strong bat- 
tery it is reduced. If it be living animal tissue the nutrition is 
altered, and the tissue itself decomposed. In an electrolyzed 
body the acid ions formed go to the anode, and the alkaline to 
the cathode. When the electrodes are of a metal that is not 
attacked, as platinum or gold, and the electrolyte an organic 
body, the acid and alkaline ions that are set free have a cauter- 
izing effect on the tissues, producing eschars. But if the elec- 
trode is a metal that can be acted upon, the ion will expand its 
chemical force on the electrode, thus the action may be greatly 
modified, according to the nature of the electrode used. Plati- 
num being the least attackable, is the best electrode, while 
copper, and others that are easily acted upon are themselves 
decomposed. From the separation of the products of decom- 
position, we have an easy and positive means of producing 
cauterizations by the action of acids or alkalies, that can be 
alternated and the amount governed by the quantity and qual- 
ity of the current. 

The history of the use of electrolysis for stricture of the 
urethra does not date back many years. The first to use 
electrolic treatment was Crusell, of Saint Petersburg, who in 1841 
communicated papers on its use for certain engorgements of 
the urethra, to the Academies of Sciences, of Saint Petersburg 
and Paris. But it is to Drs. Mallez and Tripier, of Paris, that 
we are indebted for the present knowledge and improved means 
and methods of application. Dr. Tripier observed {Archives 
Oeneralea de Medicine, January, 1866) when engaged in the 
capacity of exteme in the Children's Hospital, of Paris, that the 
applications of various caustics, used in the treatment of certain 
scrofulous affections, produced different qualities of cicatrices. 
''Some were soft and flat, or even depressed; others were hard, 
and often projecting above the free surface." On investigation 
he found the former were produced by alkaline, the latter 
by acid, caustics. The nature of the alkaline eschar being 
soft and non-retractile, led to the negative electrode being used 
for the destruction of strictures. Mallez and Tripier, in a 
pamphlet published in 1867, report forty cases. They used 
from five to twenty elements, each seance lasting ten to'fifteen 



StftlOttTBB Ot tME ttRttTHllA. 8 

mincites. They were not painful, but in most cases a small 
amount of hsemorrhage would follow the removal of the bougie. 
In most of the cases a large sized instrument which could not 
pass the stricture before, would easily pass after the current 
had been used. In a few days the eschar would be exfoliated 
and the cure complete and permanent. The procedure was 
followed with more or less slight constitutional disturbance. 
Twelve cases are reported by Couriard, of Saint Petersburg, who 
did not meet with the same success as Mallez and Tripier. He 
did not find it applicable in all cases but prefers it to urethot- 
omy'in cases that do not yield to dilatation. 

'While electrolysis has not met with very great success at 
the hands of American physicians who have given it a trial, I 
have had gratifying results, as have also two fellow practi- 
tioners to whom I recommended it for trial in cases where it 
was thought to be appropriate. 

Case L — Mr. Wm. M., aged twenty-seven. Contracted gon- 
orrhoea, for the first time al^out six or seven years ago, and has 
had the disease several times since. About eighteen months 
ago he had a hard chancre, for which he took treatment for 
some time. When he came to me he was sufiering from sec- 
ondary symptoms of syphilis. About two years ago he 
noticed the size of the stream of urine was smaller, which 
gradually continued to grow less. When he began treating 
with me he could pass his urine only a few drops at a time. 
Upon examination I found two strictures. A full sized sound 
would pass but a short distance; a number three and one-half 
passed the first stricture with difficulty, but I could get no 
mstrument through the second. I should have mentioned that 
there was a thick gleety discharge. Believing this to be a good 
case for electrolysis, I determined to use it. I employed the 
method of Dr. Newman, of New York City, who kindly aided 
and instructed me in electrolic methods. This consists in 
attaching the negative pole to the bougie, which is passed into 
the urethra as far as the stricture, and placing the positive pole, 
which is protected with a sponge, over the groin, perineum, or 
scrotum. This instrument whiph I exhibit for your inspec- 
tion, is an elect! ode bougie. It is an insulated sound, with an 
exposed metallic bulb. I began treatment December, 1883, 
with a number twelve bougie. When first introduced it was 
firmly resisted by the stricture. After the current had been 
used for five minutes it passed easily through both strictures 
into the bladder. I used twelve cells of a Mcintosh galvanic 
battery. Four days later by means of the same current I was 
able to pass a number fourteen, and in seven days used a num- 
ber eighteen with no difficulty. In seven days the instruments 
were passed a third time, using eighteen cells, when a number 
twenty-three readily entered the bladder. After this on two 
different occasions I used two larger sounds without electricity. 



4 STRICTURE OP TtJE tTRETHRA. 

No farther use of instruments was made and the patient has 
had no more trouble. To satisfy myself, about two months 
ago I passed a number twenty-six without any diflSculty. 
With the exception of the first time the patient never made a 
complaint of tne electrolysis hurting him. No force, whatever, 
was used, the bougie was retained at the point of stricture 
from five to eight minutes, when the tissues would yield and 
the instruments would glide through. In this case the first 
structure was one inch and a quarter from the meatus, the 
second nearly three inches. 

Case IL — Mr. P. S. Stricture of four years standing. Sounds 
had been used for some time by several physicians, and in 
order to retain relief, instruments had to be repeatedly passed, 
which was a great inconvenience to the patient. Number 
twelve was the largest instrument that could be passed. Elec- 
trolysis was begun January, 1884. The first time it was used a 
number fourteen was passed ; the second use a number seven- 
teen, a number twenty the third, number twenty-one the 
fourth, number twenty-three the fifth. Each use of the elec- 
trolysis was five days apart. At his next visit I passed a num- 
ber thirty (English) without electricity and dismissed him 
cured. I saw and spoke with the patient last week, about his 
condition, and according to his statement, he has had no more 
trouble. 

These two cases are the only ones in which I have used 
electrolysis that it proved appropriate, but in these the results 
have been so gratifying that I shall continue to use it in similar 
cases, namely, in long-standing chronic cases. Two brother 
practitioners in this city have made use of electrolysis in three 
cases with the most happy results. In acute cases I have not 
found it of any benefit, and it is much more painful. 

I have employed electricity in the treatment of sperma- 
torrhoea, prostatorrhoea and stricture of the rectum, with grati- 
fying success, with the exception of prostatorrhoea. 

From the results which 1 have obtained from the use of the 
current, I shall continue to employ it in my practice. It would 
have given me pleasure to have been able to give you more of 
the detail in the efiiects of electrolysis, and to have dealt more 
in the particulars of its application in the treatment of neu- 
rasthenia in its various forms, but the short time in which 
this paper was prepared, did not give me the opportunity, it 
being only this noon that our worthy president appealed to me 
to read an article at this meeting. 

The practical applications of electrolysis are yearly becom- 
ing more numerous and varied. It has been successfully used 
in many forms of abnormal growths. Nsevi, erectile tumors, 
goitres and cancers Gave yielded to the current. It seems 
especially suited for destroying venous nsevi. In a few moments 
the vascular mass becomes a firm coagulum. 



HEALTH IN MICHIGAN. 



GENERAL CORRESPONDENCE. 



HEALTH IN MICHIGAN DURING NOVEMBER, 1884. 

Reports to the State Board of Health, Lansing, bjr observers 
in different parts of the State, show the diseases which caused 
most sickness in Michigan during the month of November, 
(four weeks ending November 29), 1884, as follows: 



Number of Weekly Reports received, 172. 



Diseases arranged in order of greatest 
prevalence. 



Neuralgia 

Rheumatism.. 

Bronchitis 

Intermittent fever 

Consumption, of lungs 

Tonsilitis f. 

Diarrhoea 

Remittent fever 

Inflaensa. 

Typho-malarial fever.„ 

Pneumonia 

Erysipelas 

Typhoid fever (enteric) 

Diphtheria.. 

Inflammation of the bowels. 

Scarlet fever 

Whooping-cough.. 

Cholera morbus 

Membranous croup..... 

Dysentery 

Cholera infantum 

Inflammation of brain 

Measles 

Puerperal fever , 

Cerebro-spinal meningitis...., 
Inflammation of kidneys...... 



Per cent, of re- 
ports stating 
presence of dis- 

ease. 



For preceding 
month. 



Per cent of re- 
ports stating 
presence of dis- 
ease. 




64 

67 

66 

72 

60 

44 

76 

62 

37 

36 

22 

28 

26 

22 

22 

9 

16 

31 

8 

44 

28 

8 

6 

6 

7 

22 



For the month of November, 1884, compared with the pre- 
ceding month, the reports indicate that tonsilitis, bronchitis, 
neuralgia, and pneumonia increased, and that dysentery, 
diarrhoea, cholera infantum, inflammation of kidney, cholera 
morbus, intermittent fever, end remittent fever decreased in 
prevalence. 

Compared with the average for the month of November in 
the six years, 1879-1884, diarrhoea was more prevalent, and 
diphtheria, intermittent fever, and consumption, of lungs, were 
less prevalent in November, 1884. 



r 
I 

L. 



6 WATER IN HABITUAL CONSTIPATION. 

For the month of November, 1884, compared with the 
average of corresponding months for the six years, 1879-1884, 
the temperature was slightly lower, the absolute humidity and 
the day and the night ozone were less, and the relative hu- 
midity was more. 

Including reports by regular observers and others, diph- 
theria was reported in Michigan in the month of November, 
1884, at forty places, namely : Adrian, Alton, Armada, Bloom- 
ington, Byron, Big Rapids, Constantine, Cooper, Decatur, De- 
troit, East Saginaw, Evangeline, Fruitland, Grand Rapids, Has- 
tings, Howard City, Kalamazoo, Lansing, Leeland, London, 
Muskegon, Manistee, Mendon, Orange, Pinconning, Portland, 
Port Huron, Portage, Pontiac, Romeo, Richmond, Smiths 
Creek, Schoolcraft, Vicksburg, Vernon, Vergennes, Vassar, Wyan- 
dotte, Warren, Wat ervliet; Scarlet fever at twenty-two places — 
Albion, Algonac, Armada, Brockway Center, Cadillac, Center 
Plains, Detroit, East Saginaw, Freesoil, Grand Rapids, Kalama- 
zoo, Lansing, London, Manistee, Muskegon, North Muskegon, 
Pontiac, Portland, Roxand, Saint Johns, Vassar, Vicksburg; 
Measles at six places— Detroit, Grand Rapids, Kalamazoo, Port 
Huron, Saint Johns, and Whitehall. 

Henry B. Baker, Secretary. 

Lansikg, December 5, 1884. 



WATER IN HABITUAL CONSTIPATION. 



Editor of The Physician and Surgeon : In the December 
number of your journal I see an article entitled ** Water and 
Constipation," in which you are made to say that " water, as 
every one knows, will not cure habitual constipation in a very 
large percentage of cases." This, I am inclined to think, is a 
mistake. My experience (both upon myself and my patients) 
is, that water, if properly used, will cure a large per cent of 
cases of habitual constipation. I tell such patients, as does 
Dr. Squibb (whom you quote in the article above mentioned), 
to drink water; drink beyond the demands of thirst; especiaUv 
drink before breaking fast. But "drink water," "first, last and 
all the time." The simple practice of drinking cold water be- 
fore breakfast has, to my certain knowledge, relieved a great 
manv cases of this troublesome complaint. Of course dietarv 
regulations are highly important but most of the cures which 
have came under my observation were where no change in diet 
was made. 

I give the above to vou for what it is worth, and would be 
pleased to hear the result of a fair trial from any of your sub- 
scribers who may chance to read this and who may be troubled 
with constipation. 

R. P. Comfort, M. D. 

M cBmpb, Micbigak, December 22, 1884. 



OVARIAN CYSTS. 

ORIGINAL TRANSLATIONS. 



FRENCH LITER A TXJRE. 
Tbimilatid by & J. WHITEHEAD, A. B., Ami Abbob. Mxchioui. 



ON THE RELATION OF OVARIAN CYSTS TO THE URINARY 
ORGANS, WITH THE FUNCTIONAL DERANGEMENTS AND 
DIFFICULTIES IN OPERATIONS THAT RESULT FROM IT. 



When the adhering bladder remains in place it can be 
wounded only on undertaking to dissect off the tumor; but 
when it has been pushed along by the growth of the cyst, two 
entirely different conditions are possible. 

In the first place, if the bladder adheres at the same time to 
the abdominal wall, and to the cyst, there is the danger of open- 
ing it in the first part of the operation. The surgeon does not meet 
with the peritoneal cavity, and cuts the wall of the bladder, 
thinking he has merely to do with some of the false membranes 
that are frequently found between ovarian tumors and the 
abdominal walls. But the appearance of the parts when they 
are cut through, affords means for a diagnosis. 

In the second place, if the bladder, adhering to the cyst, but 
free from the abdominal wall, has risen above the pubis, there 
is danger of injuring it at a later stage of the operation. It 
sometimes happens that adhesion having taken place over a 
limited area only, a more or less considerable diverticulum is 
formed, the communication of which with the lower portion of 
the bladder, is represented only by a narrow, flattened orifice 
behind the pubis. 

In other cases the vesical wall is separated and spread out. 
This renders the recognition of the tissue difficult. 

It is not easy to make, in advance, a correct diagnosis of 
the different kinds of adhesions. The firm condition of the 
uterus, the presence of cystic prolongations in the pelvis, show, 
it is true, the possibility of close connection between the tumor 
and the bladder, but these indications are not exact; it is the 
same with a careful examination of the bladder, which, although 
it shows the size and situation of the organ, cannot enable one 
to know beforehand the number and character of the adhesions 
that unite the cyst to the bladder. 

M. Terrillon has found twenty-five cases of laceration of the 
bladder during ovariotomy; of these fourteen died, and eleven 
recovered. 

An analysis of postmortem examination shows that the 
fatal termination was due, not so much to the wounding of the 
bladder, as to the length of the operation and to the lesions 
produced in the peritoneum by the separation of extremely 
close adhesions. In several cases, in spite of a vesical suture as 
exact as possible, a secondary urinary fistula was caused. * 



8 EKf BANCS OF AIR U9T0 VEIM8 OF UTERUS. 

The author mentions the fact thatSimon, in a case of fistula 
of the right ureter following an operation, had recourse suc- 
cessfully to the removal of the corresponding kidney. — ^Terrillon 
in AnnaUs des Maladiea dea Organs Genito- ^naries. 



GERMAN LITERATURE. 
Teakslated by E. J. WHITEHEAD, A. B., Anw Arbor, Micuigaiv. 



DEATH CAUSED BY ENTRANCE OF AIR INTO THE VEINS OF 

THE UTERUS. 



Several instances are recorded of sudden death following 
intra-uterine injections that can be accounted for only by the 
supposition that they were caused by the entrance of air into 
the veins of the womb. Such is the case mentioned by Oles- 
hausen. He gave a women in childbirth a uterine injection 
to hasten dilatation of the cervix. The woman immediately 
complained of pain, rose up in bed, and was dead in less than 
a mmute. 

An autopsy made eight hours after death showed the pres- 
ence of a large number of air-bubbles in the cavities ot the 
heart, in the uterine veins, the veins of the broad ligament, and 
in the inferior vena cava. 

Litzmann records a similar instance. Wishing to bring 
about premature delivery in the case of a woman in cramps, 
and having given her four uterine douches with Mayer's 
syringe, he saw the woman suddenly become livid, and die in a 
few seconds. 

An examination six hours after death showed that bubbles 
of air filled the veins of the uterus, the ovarian plexus, the renal 
veins and inferior vena cava. The heart contained frothy blood, 
the placenta was torn away for a distance of about five cubic 
centimeters on its lower border, where appeared to be the point 
of entrance of the air injected with the liquid. 

Gunz relates the case of a women twenty years old, found 
dead in her room. She still had between her legs a syringe 
with the nozzle remaining in the vagina. 

Autopsy showed that she was three months pregnant, and 
death was due to the entrance of air into the uterine veins, the 
canula end of the syringe having entered the cervix. 

It is easy to explain such accidents ; the injected liquids are 
always mixed with a certain amount of air, which is sucked up 
by the gaping veins of the uterus. In those cases where death 
has occurred suddenly without any injection of liquid, whether 
with criminal intention or not, the result may be explained by 
the accumulation of air in the vagina, and also in tlie womb, 
these organs being largely distended, especially after delivery. 

The introduction of air in this case may perhaps be caused 
by the elevation of the pelvis and movements of the womb. A 



ULPABOTOMY FOR TUM0R8. 9 

woman multipara, aged twenty-five, and healthy, gave birth 
without accident, to a child weighing five and one-fourth 
pounds. After the birth of the child, the woman who was lying 
on her left side, was turned upon her back and the abdomen 
in the region of the uterus was lightly compressed. The ex- 
pulsion of the after-birth soon followed. All at once the wom- 
an's face became blue, respiration difficult, the pulse feeble, and 
after several convulsive movements the woman died. Cardiac 
paralysis was caused so quickly that there was no time for tie- 
ing the limbs and injecting ether. Death was not due to hsem- 
orrhage, because the amount of blood lost did not exceed 
twenty-five ounces. 

An autopsy made twentv hours after, showed the uterus 
larger than a child's head, the walls relaxed, and the cervical 
canal enlarged. On compressing the posterior wall and the 
fundus on a level with the points where the placenta adhered, 
slight crepitus was heard, and on plunging the uterus into water 
a large number of air-bubbles were seen to escape. Larger bub- 
bles came from the deep veins on* cutting tne uterus. The 
region near the cervix dia not appear to contain air; the bub- 
bles were also absent from the veins of the broad ligaments, 
the veins of the ovaries, and from the inferior vena cava. But 
they were found in all the veins of the cervix ; and, especially, 
completely filled the veins of the heart, even to their finest 
ramifications. The blood in the right ventricle was frothy. 
The viscera were light colored, the lungs slightly oedematous. 
There were in the viscera some scarcely perceptible signs of 
putrefaction. — Dr. Braun in Weiner Medical Wochenschrift. 

LAPAROTOMY FOR TUMORS OF THE FALLOPIAN TUBE. 



Dr. Martin, of Berlin, reports eight cases of tumors of the 
Fallopian tubes. Five were hydrosalpinxes (in six cases on 
both sides), two were pyosalpinxes, one was a case of hsemato- 
salpinx occurring on both sides. Six of the patients were 
married. 

These tumors are most^ frequent in women between twenty 
and forty years of age, and are also more frequent in married 
than in unmarried women. Too frequent sexual intercourse 
seems to promote their growth. They often occur on both sides, 
differing m this respect from ovarian tumors, which are usually 
found on one side only. 

In only two of the cases was there irregularity of menstrua- 
tion, while according to Hausamann's observation, irregularity 
is the rule. The symptoms of which the patients complained 
did not point directly to disease of the tubes, but were of a 
general nature, as is usually the case in abdominal diseases of 
women. Nothing was felt of the beating pain in the hypogastric 
and pubic regions, which Lee considers characteristic. But it 



10 CHILDBIRTH WITH CONSTRICTION. 

is worth noticing that sterility was common, even in cases 
where the uterus and the ovaries were not diseased. 

Four of the women had gonorrhoea. Hennig and Schroeder 
have previously called attention to such cases. The tumor 
always arises from acute or chronic inflammation of the tube. 
As a result of the inflammation there is always agglutination 
of the fimbriae, and consequently the tube is closed, resulting in 
engorgement of the vessels. It is quite probably that extrava- 
sation of blood may be caused hy a wound, or that a hydro- 
salpinx may become a pyosalpmx. A hydrosalpinx prob- 
ably exists when the abdominal wall being thin, and both 
ovaries being easily perceptible to the touch, there is a cylin- 
drical growth, gradually mcreasing in size, and tapering to a 
point towards the uterus. The uterus is movable, and often 
pressed out of its proper ])lace. Often they increase rapidly 
from the beginning, and bring on peritonitis — usually with a 
fatal result. In other cases there may be adhesions to sur- 
rounding organs, causing constant pain by the pressure upon 
the broad ligament. 

Dr. Martin considers catheterization impracticable and dan- 
gerous. Neither does he favor the attempt to remove the con- 
tents of the tumor through the cavity of the uterus by external 
pressure. The danger is also too great to justify an attempt to 
remove the contents through the abdominal cavity. He next 
considers puncture of the vagina, of the rectum, and of the 
bladder. The first of these methods is the only one of the three 
that is justifiable. Laparotomy is advisable when the patient 
is sufiering greatly, when there is increasing emaciation, when 
the tumor, though adherent, is not completely developed, or 
when the tumor, although not adherent, cannot be easily 
reached. With the present method of performing this opera- 
tion resulting peritonitis is not a contra-indication. Laparot- 
omy is, on the other hand, not advisable, if the tumor shows 
adhesions only in Douglas's cul de sac, and puncturing is easy. 

The chances for recovery are about the same as for compli- 
cated ovarian tumors. — SchmidVs JahrbUcfier, Band CCI, Num- 
ber II. 

A CARE OF CHILDBIRTH WITH CONSTRICTION IN THE (TRUE) 
PELVIS OF A CYST OF THE RIGHT OVARY, COMPLICATED 
BY HYDROSALPINX AND TUMOR OF THE LEFT OVARY. 



A woman, aged thirty-one, the mother of seven children, had 
passed through previous confinements safely. In only one 
instance had she had a physician. Labor pains began January 
29, 1883, and became more severe the next day. The liquor 
amnii had escaped, but parturition had made no progress. The 
midwife supposed the difficulty was due to funis prsevia. The 
writer found the vaginal portion very short, the cervix dilated. 



PJ5CAL FIBTULA AT THE SCROTUM. 11 

Somewhat above lay the cranium of the child, movable, and 
with the posterior fontanelle to the right. The posterior wall 
of the vagina was pressed forward by a tumor projecting down- 
ward into the (true) pelvis. On the lower part of the tumor 
moverable tubercles about the size of a hnzelnut could be felt. 
It was doubtless the presence of these that misled the attend- 
ant. Further examination showed that the trouble was due to 
the presence of an ovarian tumor wedged into the pelvis, and 
that what the midwife had mistaken for the cord was really a 
hydrosalpinx. During a pause in the labor pains an easily 
successful attempt was maae to replace the ovary. The head 
of the child then entered the pelvis. 

As the pains had by this time almost entirely ceased, the 
physician removed the child with the forceps. The infant was 
alive and uninjured. In about twenty minutes the after-birth 
came awav. Immediately an ovarian tumor on the left side 
was plainly felt in the umbilical region, while the right ovary, 
which had been replaced, could now scarcely be determined 
externally. The woman's recovery was rapid. 

The interesting feature in this case is the occurrence of preg- 
nancy with a tumor in each ovary. Especially noteworthy 
is the iortunate result, since according to Oleshausen, in every 
other similar case the mother died. 

As far as the treatment of such cases is concerned, the writer 
considers that the best course is to replace the ovary, even if 
considerable force were required. In cases that were unsuccess- 
ful he would try puncture. If rupture of the cyst should take 
place in consequence of the replacement, even that would be 
much less dangerous than puncture. — Dr. Hoehne in SchmidVa 
JahrbUcher. 



GERMAN LITERATURE. 
Tbanblatbd by J. A. BOBB, Ann Abbob, Micbioan. 



A ¥JEJCkh FISTULA AT THE SCROTUM OF A CHILD FOUR 

MONTHS OLD. 



BY PROFESSOR R. POTT. Halle. 



Gustavus Huhn, four months old, Magdeburg, was bom at 
the end of the ninth foetal month. He was perfectly well up 
to the fourteenth dav after birth ; when there appeared in the 
middle of the right half of the scrotum a small red spot which 
increased perceptibly in size. The scrotum became dark-red, 
shining, and swelled to about four times its normal size. In 
about three weeks the inflammation reached its maximum. At 
the anterior wall of the right side of the scrotum, the integu- 
ment was perforated, and secreted pus. The swelling of the 
scrotum slowly subsided. The perforated opening closed itdelf 



12 FJECAL FISTULA AT THE SCROnTM. 

to a small fistula, through which, three weeks later, escaped 
fsecal matter and intestinal gas. From the very beginning fsecal 
matter passed through it at each defecation. Likewise thin, 
greenish fsecal matter passed through the small opening by 
each crying, straining, or coughing ,with a hissing sound. The 
mother observed that the matter passed through the anus and 
through the fistula was always of the same character. Later 
the fistula gradually closed and in time the fsecal matter ceased 

EassiDg through it entirely. Disturbance in digestion now 
ecame very troublesome. The child had pain in the stomach 
and defecation followed each violent screaming, straining, or 
pressing. The urinary secretions were in no way influenced ; 
they were always normal. 

I saw the child for the first time the 8d of February, 1883. 
The boy was well nourished, and corresponding to his age (four 
months) was normally developed. In the middle of the ante- 
rior wall of the right half of the scrotum, one-half centimeter 
from the raphe, a funnel-formed depression was observed. Here 
the epidermis was wanting; the place appeared dark-red, and 
emitted moisture. Small creases and excoriations were found 
corresponding to the diagonal folds of the scrotum. The integ- 
ument of the remaining part of the scrotum was neiUier 
inflamed nor thickened. At the deepest part of the funnel- 
shaped depression a small — only the size of a very thin copper 
wire — opening was observed, out of which spontaneously and 
by pressure, a greenish-yellow, foamy matter passed in large 
drops. This matter was similar in color and consistency to 
Ihat which passed through the anus; and microscopical exam- 
ination placed it beyond doubt that both excrements were 
identical. Inside the scrotum was felt a sound cord from four 
to five centimeters long and the thickness of a lead pencil, 
extending from the bottom of the funnel-shaped depression of 
the scrotum, in a diagonal direction upwards and outwards. 
When this spongy cord was pressed, the before-mentioned 
greenish fluid would pass through the fistula with a hissing, 
cooing sound, so that the impression of passing air was dis- 
tinctly felt. The right testicle was easily felt in the lower part 
of the scrotum, and the spermatic cord passed along the outer 
border of the cord-shaped structure In uie middle of the right 
inguinal fold lay a longish, oval, movable tumor, about the size 
of a plum pit; on the left side lay a similar one, the size of a 
pea; and as the left testicle was found in its normal position in 
the scrotum, the two tumors in the inguinal folds could onlv 
be diagnosticated as enlarged inguinal glands. The cord which 
extended from the scrotal fistula towards the inguinal canal 
was not reducible. A breach opening was not estaolished with 
certainty, nevertheless, it must be diagnosed as a Jiemia vagivr 
alia inguinalia dextra^ which has grown fast at the end at least, 
with the inner Wall of the scrotum. 



LECnmE 01^ AtoOMlNAL 8UR0SBT. 1*^ 

Kocher (Hemien im KindesaUer^ seite 750) remarks concern- 
ing this, that in irreducible hernia we must always suspect that 
the contents of the breach is composed of the apendix vermi- 
formis; of course only when the hernia is on tne right side. 
Sometimes the apendix vermiformis is also found as the only 
contents in inguinal hernia (Guersant, Demme). 

It is very doubtful whether this last condition was applica- 
ble in this case, as in this child only minor disturbances took 
place during aefecation; very seldom were the disturbances 
severe enough to correspond to such a condition. At all events 
all appearance of incarceration have failed thus far. 

We cannot well explain the origin of the fistula, and the 
closing up of the intestinal fold within the scrotum, otherwise, 
than that a part of the closed intestinal fold became gangren- 
ous, perforated, causing inflammation of the peritoneal cover- 
ing, developing a local phlegmon which broke open and left a 
faecal fistula. 

In regard to treatment Gooch and Ormsby treated two sim- 
ilar cases; one, a child three years old, the other six weeks old. 

We were obliged to desist from a surgical operation in this 
case as the mother of the child was unwilling to concede to 
such an operation. ^^__^„ 

CLINICAL LECTURES. 



AN ABSTRACT OF A CLINICAL LECTURE ON ABDOMINAL 

SURGERY. 



BY DONALD MACLEAN, M. D., 
Profenor of Surgery and Clinical Suiigery in the University of Michigan. 

RZFOBTED BY WARREN B. SEXTON. 



Gentlemen: Two weeks ago to-day the patient before you 
walked into this amphitheatre and we then made a careful 
examination of an abdominal tumor, which from its appear- 
ance, situation, and history, we supposed or rather suspected to 
be ovarian. 

Two days after that examination, she was operated upon 
here in your presence. It was then found necessary to remove 
her left kidney, and both her ovaries, together with a large mass 
of the great omentum. The tumor which we had supposed to 
be ovarian, proved to be the left kidney, enormously enlarged 
and cystic. Both ovaries were also cystic. In addition to this 
the uterus presented marked evidences of being pregnant.''' In 
performing this operation it was found necessary to leave a 
large number of ligatures (cut short) in the peritoneal cavity. 

^Ulterior developments showed that the uterus was not pregnant, 
and that serious complications arose which will be given in the full 
report of the case. 



14 LECTURE ON ABDOMInAL StTBOJSRY. 

To-day is the fourteenth day and I am very glad to be able 
to present the patient to you in an advanced et^e of convales- 
cence; her wound healed, the stitches removed, the secretions 
natural, the temperature normal, the countenance bright, in 
short, every indication of a speedy^ and complete recovery. 
You will remember that our patient is a marriea woman, aged 
twenty-seven, the mother of two living children. 

Before going further let me impresss upon you the fact, that 
a full and precise diagnosis in this case was not possible until 
the abdommal cavity was opened, and even then the difficulties 
were vety great indeed. We had to proceed with an unusual 
degree of hesitancy, cautiously feeling our way through an 
intricate tingle of abnormal structures, the precise nature and 
relations of which, it was well nigh impossible to unravel. The 
operation lasted, I am told about thirty minutes, and the 
patient's appearance now furnishes the most satisfactory evi- 
dence, that all the dangers and risks inherent in such an oper- 
ation must have been safely avoided or provided for. 

Her record shows one serious drawback, which may be met 
in the healing of the wound in any surgical operation. At times 
there were sudden elevations of temperature, and other indica- 
tions that there was absorption of septic material, or that a pus 
cavity was in process of formation. Her tongue was air, 
rough, and red, and she was restless and uncomfortable. In 
abdominal surgery these are unfavorable indications. The 
cause of this disturbance was carefully sought after, and it was 
found to be due to the formation of small abscesses along the 
incision, at the seat of the silk sutures used to close the wound. 
This occurrence is an unusual one in my experience, in the 
healing process of abdominal incisions. Whether it is due to 
some defect in the mode of preparing the silk used, or to the 
effect of the fluid of the cyst, I cannot say. 

As I have remarked a large number of ligatures were left 
in the peritoneal cavity, but by this time they are all enveloped 
in a thick deposit of inflammatory new-formation. Being thus 
protected they will not be the source of any trouble. I have 
never had any suppuration at the seat of ligatures. All the 
postmortem examinations that I have had the unfortunate 
privilege to make, showed the ligatures covered up and com- 
pletely encysted. 

The other two abdominal operations which you have wit- 
nessed this term were not so desperate. Although the one previous 
to this was in some respects less favorable for recovery. Your 
notes of the case will show her to be a woman aged sixty -eight 
years, feeble and emaciated. The tumor weighed forty-five 
pounds. Moreover, there existed adhesions that necessitated the 
removal of a great portion of the omentum. The haemorrhage 
from surfaces where firm bands were divided was free and obsti- 
nate. A number of ligatures had to be used and there were 



JJSCrUUk ON ABDOMINAL SUBaBRY. 15 

in all thirteen silk ligatures left in the peritoneal cavity. The 
operation was on Monday; on the lollowing Saturday the 
patient was brought before you and the sutures removed, and 
one week from that day she left the hospital for her home, 
cured. 

The other case, Mrs. M., aged fiftv-three years, was a very 
favorable one. The tumor was a simple ovarian cyst, moderately 
large, and free from adhesions. The peritoneal cavity was not 
open more than eight minutes. She was returned to her room 
in twenty minutes from the time she left it, and returned home 
cared in two weeks fiom the date of the operation. 

Let our review of this class of operations go back farther. 
Within fifteen months previous to the first of these later cases, 
and within the recollection of many of you who are now pres- 
ent as students, there have been four other ovarian tumors 
removed in this amphitheatre, under similar circumstances, 
exposed to the same atmospheric impurities and septic dan- 
gers, as the cases just enumerated. Not one of the four could 
be regarded as a favorable case for operation. Three of the 
patients had reached the age when the reparative processes of 
nature have lost their force and activitv. They were debilitated 
and their strength so exhausted and so enfeebled that a sur- 
geon more jealous of his statistics and reputation, than of 
the interests of his patients, would not have operated. Yet 
all three cases got well, making very rapid, and I may say, 
brilliant recoveries. The other case was quite remarkable 
for several particulars. The patient was a young woman ; her 
strength had not yet become impaired; she was strong and full 
of hope and courage. The tumor was large, and was growing 
rapidly, but the one remarkable complication in her case, was 
a large gravid uterus, the patient being in the seventh month 
of pregnancy. In consequence of the rapid increase of the 
tumor and the intense sufiering which it occasioned, there was 
no choice but to operate at the earliest possible moment after 
the patient presented herself at this clinique. The operation in 
every particular passed off satisfactorily. It was done rapidly, but 
gently, and safely. The peritoneal cavity was open not longer 
than fifteen minutes. The uterus was handled with the utmost 
gentleness and received the least possible amount of manipula- 
tion, nevertheless, labor pains came on in a few hours and the 
woman sank under the combined shock of the operation and 
the miscarriage. 

This completes the list of ovariotomies performed in this 
clinique and hospital during the time specined, making seven 
operations; six recoveries and one death. The latter clearly 
independent of anything like septic influences. 

Two weeks ago I operated upon Mrs. O., at Otisville, in this 
State, in her own house, and amidst surroundings the most 
un&vorable and discouraging that could possibly be imagined. 



16 LECTURE ON ABDOttJNAt SUBOBRV. 

The patient was sixty-three years old. The as tumor wlar^e, 
multiiocalar, extensively adherent, had been antapped,d tne 
cysts contained enormous quantities of purulent nuid and 
masses of inflammatory lympth. I never had the privilege of 
seeing Mrs. 0. until the day of operation (October 16, 1884), 
and then I had only two hours to spend there, before the train 
was due by which I returned home. Having performed the 
operation as carefully and completely as if I had the whole 
day before me, I left her in the care of Dr. J. D. Laing, from 
whom I received daily reports as to her symptoms and condi- 
tion for two weeks, at the end of which time he pronounced 
her cured. Being financially poor, and physically in an ad- 
vanced stage of exhaustion, her removal from her bed or her 
home to any more comfortable or healthy surroundings, much 
as that was to be desired, was simply impossible. Not only so, 
but the patient had remained firm and immovable in her deter- 
mination to be operated upon in her own home or not at all. 
We had, therefore, no choice but to operate where we did and 
as we did, or else leave the unfortunate patient to her miser- 
able fate. 

Again on the 30th of October last, I performed ovariotomy 
upon Mrs. W., of Manchester, in this state, under circumstances, 
which, if we except the age of the patient, were more unfavora- 
ble and deplorable than those of the case just described. The 
patient, Mrs. W., is thirty-eight years old. Her tumor had 
grown rapidly, having commenced, so far as could be discov- 
ered, just ten months before I saw her. She also was a poor 
woman, and all her surroundings accordingly unsuitable for 
the safe and satisfactory performance of any surgical proced- 
ure. She was much emaciated and greatly exhausted. Her 
tumor, along wUh the ascitic fluid vMkdravm from the abdom- 
inal cavity at the time of the operation, weighed one hundred 
and three pounds. Owing to the enormous distension of her 
abdominal cavity, and pressure upon the thoracic viscera, she 
was unable to stand on her feet, lie on her back, or turn over 
in bed. Her removal, therefore, to any more favorable place 
for operation, desirable as it might have been, was a physical 
impossibility. Here we had once more to choose oetween 
operating there and then or abandoning her to her fate. We 
chose the former, and the result has demonstrated the correct- 
ness of our course. The patient has made a rapid and most 
satisfactory recovery. Before leaving this case, 1 should men- 
tion the fact that the tumor was multilocular, and some of the 
larger cysts were filled with a semi-solid mass presenting a 
striking resemblance to soft soap. I will also mention the fact 
that the case had not been seen by me before the time of the 
operation, nor have I seen her since. The after-treatment was 
placed in the care of her family physician. Dr. A. C. Taylor, 
of Manchester, assisted by my brother, Dr. A. M. Maclean, and 



tfeCTURE ON AfeDOHllNAL BtJRGERV. 17 

then by Mr. Julius Noer, a member of this class, who was sent 
from here to remain a few d<iys by the patient's bedside. 

You will note that we have now described five cases oper- 
ated upon within the month of October last. Three here in 
your presence, including the case of extirpation of kidney, and 
two in remote country villages. All have made rapid recoveries. 

Going three or four months farther back in the retrospect, 
I have to record three cases operated upon by myself in the 
public amphitheatre of Harper Hospital, Detroit, during a 
time when, to my certain knowledge, erysipelas, diffuse suppu- 
ration and diphtheria existed in the institution. Three cases, 
which as regards the character and relations of the tumors, and 
the general health of the patients, might be truthfully described 
as desperate. Of these three two were dismissed cured^inside 
of three weeks from the date of their operations. The third, 
the most desperate of all, a case which my professional breth- 
ren, who were present at the operation, without a dissenting 
voice, regarded as practically beyond the reach of hope, was 
dismissed cured, after eight weeks of the most careful and 
devoted after-treatment. 

In the latter part of July I performed ovariotomy upon a 
lady, aged sixty years, in delicate health, at Midland City, this 
State. Owing to a very large adhesion, which was broad, thick, 
and short, and very vascular, the operation was made difficult 
and tedious. Every effort was made and all possible care taken 
to prevent and control hseraorrhage from this peculiar structure. 
When the cavity was closed it seemed that every vessel had 
been secured and all oozing stopped. But at the end of twenty- 
four hours, without a previous bad symptom, she began to sink 
rapidly, and in a few hours life yielded to an easy, painless 
death. No postmortem was allowed, but the mode of death 
suggests internal hsemorrhage as the cause. 

A short time prior to the operations in Harper Hospital, I 
had two cases in the city of Detroit. Both operations were 
performed in private residences. The hygienic surroundings, 
in both instances were as bad as it is possible to imagine; one 
being a third-rate boarding house in a cheap back street of the 
city. In this case both ovaries were removed. The other, a 
small room about twelve feet by fourteen feet, one door of the 
room opening on a damp, foul street, and another into the 
kitchen. These cases were dismissed cured within two weeks 
from the date of operation. 

But our list is not yet completed. On the 15th day of Jan- 
uary, 1884, 1 went to the city of Kalamazoo, in this State, for 
the purpose of performing ovariotomy on a young lady eighteen 
years of age, who insisted upon having her operation done in 
her own home. But for the existence of glycosuria, the case 
was in all respects a favorable one for operation. The patient 
was not on the operating table more than fifteen minutes* 

B 



18 t:kGTUBte ON ABDOMINAL SURGERY. 

The recovery in this case was rapid, uneventful, and complete. 

Immediately upon the completion of this operation, I was 
asked to see another patient suffering from ovarian disease. 
This proved to be a very different and much more unfavorable 
case. The tumor was lar^e and multilocular, the general 
health of the patient much broken down, and her spirits very 
greatly depressed. Her lower extremities were swollen to their 
utmost capacity by dropsical fluid. Notwithstanding the unfa- 
vorable nature of the case, and the no less unfavorable con- 
dition of her hygienic surroundings, I proposed to afford her 
at once, the only chance of life which remained, namely, the 
removal of her disease by operation. This proposal having 
been considered and accepted, I proceeded without further 
ceremony or delay to carry it into execution. Both ovaries and 
a large mass of adherent omentum were removed. For some 
hours after the operation the patient suffered severely from 
shock, but in due time rallied and recovered without a bad 
svmptom, and is now in the enjoyment of robust health. Even 
the habit of using large doses of morphia, acquired during the 
period of her ovarian trouble has been completely abandoned. 

The last case about which I will speak now was operated upon 
in the city of Pontiac, this state, Mrs. S., aged thirty-five. Her 
tumor was large and had been allowed to go on until the 
vitalitv of the patient was about exhausted; she was reduced 
to such an extent that even hope itself was gone. The opera- 
tion was not a difficult one, but the patient never recovered 
from the shock, and gradually sank. 

Here are eighteen cases, all that I have operated upon 
during eighteen months, with fifteen recoveries and three deaths. 
I have reviewed these cases for a double purpose; to show 
the folly and the danger of neglecting an early operation; 
and to criticise some ideas that have been recently advanced, 
regarding the place of operation and»the qualifications of the 
operator; and at the same time to protest against making 
figures the basis for estimating the value of such results as 
are here shown; the intrinsic merits, the difficulties and pecul- 
iarities should be the points considered. The eighteen cases 
here mentioned, represent the sum total of all cases of ovarian 
tumors that have applied to me during the time specified. 
The great majority being difficult, dangerous, and unpromis- 
ing cases. In view of the fact that in each case the operation 
was done with a full understanding that the patient had 
everything to gain and nothing to lose, and that it was done 
for the purpose of giving her the benefit of any possible chance 
remaining, I feel that saving fifteen lives out of a possible 
eighteen is a result which satisfies my conscience, and as a 
surgeon I can be tried before no higher or more severe tribunal. 
Claim has been made in certain quarters for the exclusive 
performance of ovariotomy in special hospitals set apart for 



IfiOTtJRE ON Al^DOillNAt StRdEltV. 19 

that purpose and by special operators, who confine themselves 
to abdominal surgery. A claim which it must be admitted 
possesses some theoretical foundation. Unfortunately there 
are practical difficulties in the way which are sufficient to 
render this claim cruel and selfish and worse than absurd. 
No stronger argument could be made against this new doctrine 
than is found in such a retrospect as we have now taken. An 
ostentatious advocate for special abdominal hospitals and spe- 
cial abdominal operators, he himself being a representative of 
the latter, at the late meeting of the American Medical Associa- 
tion, argued that for an operator to open the abdominal cavity, 
anywhere else than in a private abdominal hospital, and espe- 
cially in a public amphitheatre, amounted almost if not quite 
to the crime of manslaughter. The same speaker, on the same 
occasion used the following language: 

''If he," [the operator] "chooses to do an ovariotomy in 
the amphitheatre, in the presence of one hundred medical stu- 
dents with dust flying with zymotic influences of the dissecting 
room, I sav that, if that woman gets well in spite of all that, 
the Almigfity is to be given more credit than the operator." 

You are well aware I have always believed and taught that 
the functions performed by the surgeon, with all his skill, and 
care, and experience, as compared with those performed by 
nature are impotent and insignificant. While, therefore, we 
modestly refrain from, and repudiate any such comparison, we 
do claim on the strength of the statistics now presented, to be 
deserving of more credit, than the man who would deliberately 
consign to lingering and miserable death, all the unfortunate 
sufierers of ovarian tumors, who cannot avail themselves of 
the advantages of his special hospital and of his alleged mar- 
velous power as an abdominal operator. 

The ovarian operator should always select the best possible 
hygienic surroundings for his patient, but at the same time 
there are other matters of no less importance to be considered. 
Among these are tenderness and delicacy in all his manipula- 
tions; thorough cleanliness on the part of the surgeon himself, 
his^assistants and his appliances, the cleansing of the peritoneal 
cavity of all fluids and foreign matter of all kinds, the perfect 
control of hsemorrhage, the accurate closure of the abdominal 
wound, efficient drainage, the application of dressings such as 
you have seen us use, which are simple and comfortable, and 
efficient as a means of protection not only to the wound but to 
the abdominal cavity and its contents. This, you have noticed, 
consists of a piece of carbolized oil silk to cover the wound, and 
over this a thick padding of clean white cotton wadding, held 
in place by a flannel bandage snugly applied and secured by 
safe^ pins. 

The diet, nursing, and after-treatment will furnish a subject 
for a future hour. 



20 HISTORY. AND CLINICAL USES OF COCAINE. 

EDITORIAL PERISCOPE. 



COCAINE: HISTORY AND CLINICAL USES. 



There has not been a discovery in medicine, since Morton 
demonstrated and proclaimed to the world the power of ether, 
that has excited as much interest as the anaesthetic effect of 
the hydrochlorate of cocaine. The few months that this action 
has been known the medical journals, particularly of this 
country, have been filled with testimony to its wonderful 
power. 

Coca, the plant from which the alkaloid is obtained, is a 
shrub growing wild in South America, especially in the moun- 
tains of Peru and Bolivia, and also largely cultivated on the 
fertile plateaux of those elevated countries. It grows from the 
seed, which is sown in December and January, and under cul- 
tivation becomes four to six feet in height. The shrub matures 
in two years and continues productive for forty years and older. 
The leaf carries the active principle of the plant. These leaves 
are similar to those of the tea plant, and are gathered three 
times a year, during the months of March, July and November. 
The green leaves are carefully dried in the sun and then packed 
in bags of about twenty-five pounds each. The best samples 
of the dried leaves are uncurled and the upper surface of a 
uniform dark green; when they are not properly cured, or 
allowed to become damp, they are dark-spotted or of a brown 
color. The natives call the prepaied leaves (mca, which has 
been corrupted by the Spaniards into coca. The word should 
not be confused with cocoa^ the palm tree (cocos nucifera) which 
produces the cocoa-nut, nor with caccu)^ the chocolate tree (theo- 
oroma cacao). Many thousands of the inhabitants of Peru and 
Bolivia are employed in its culture. It is estimated that fifty 
million pounds are annually produced in those two countries, 
nearly all of which, or about forty million pounds, are con- 
sumed at home. 

The physiological action of coca was known to the aborig- 
ines of Peru before the conquest of that country by the Span- 
iards. It is now used by the inhabitants as "a tea, but the 
Indians continue to chew it in the same way that it was used 
when first noticed in the beginning of the sixteenth century. 
The leaves are masticated until they are reduced to a pulp, 
which is formed into a ball with a small quantity of quicklime 
or ashes being added to give the flavor a relish. To this quid 
fresh leaves are added, two or three ounces being consumed 
in a day. 

The ancient Peruvians used it in their religious ceremonies, 
employing it as an offering to the sun. It was regarded by 
them as a divine gift, and was called the '' divine plant,'' and 



HISTORY AND CLINICAL USES OF COCAINE. 21 

was spoken of by them as ^* that heavenly plant which satisfies 
the hungry, strengthens the weak, and makes men forget their 
misfortunes." The early Jesuits prohibited its use, inflicting 
severe punishment upon the enslaved natives who were caught 
using it; but when it was observed that, being deprived of their 
accustomed stimulant, they could not perform their tasks, they 
were permitted to use it. 

It has a mild, stimulating efiect upon both mind and body 
when used moderately. In larger quantities it becomes a pow- 
erful stimulant to the nervous system. It relieves and pre- 
vents all sense of fatigue, and by warding off the sensation of 
hunger enable continuous exertion to be borne with less nour- 
ishment than ordinary. It quickens the heart's action, and 
increases its force; stimulates respiration j increases nerve en- 
ergy; enlivens the spirits; diminishes excitability of the motor 
nerves, and benumbs all tactile sensations. 

The plant was carried to Europe in 1749, it was then 
described by Jussieu, and given its botanical name (erythroxy- 
Urn coca) by Lamarch. The leaves were fully investigated by 
Dr. Niemann in 1860, who succeeded in isolating an alkaloid, 
which he named cocaine. The original discovery of this 
alkaloid is credited to Niemann, but Dr. Samuel R. Percy, of 
New York, communicates a letter to the Medical Record, in 
which he makes a claim of priority in the discovery of the 
active principle which he called erymroxyline. In his letter he 
says: *'0n November 4, 1857, I read before the New York 
Academy of Medicine an exhaustive paper upon the leaf of the 
plant erythroxylon coca, and stated that I was busy with its 
chemical investigation. On December 2, 1857. 1 exhibited to 
the Academy one scruple of the alkaloid of the leaves, to which 
I gave the name erythroxyline.^^ Dr. Percy then called attention 
to the ''peculiar but not unpleasant benumbing and paralyzing 
effect upon the tongue " produced by the alkaloid. 

The formula for cocaine is C?^ H** NO*, It crystallizes in 
large four to six-sided colorless prisms. It dissolves sparingly 
one part in seven hundred and four parts of water at 12^ cen- 
tigrade, readily soluble in alcohol ana more easily in ether. It 
has a bitter taste and strongly alkaline reaction. Chemists 
have already prepared muriate, sulphate, nitrate, tannate and 
oxalate salts. Cocaine has nearly the same chemical formula 
as theine, caffeine, and theobromine. Dr. Squibb has shown 
that the physiological effects of all these alkaloids are very sim- 
ilar, but trials {Ephevnerisy November, 1884) of caffeine to obtain 
the anaesthetic effect of cocaine have not proven successful. 

Although the physiological action of cocaine has been stud- 
ied by a number of observers, it has not been used to any great 
extent as a medicine. In 1860 Rossbach and Nothnagle refer 
to the drug in their *^ Materia Medica" as having found no 
place in medicine, " but on account of its extraordinary effects 



22 HI8T0RY AND CLINICAL USES OF COCAINE. 

on the nervous system, re6]>iration, on the action of the heart, 
as well as for local ansesthetic effect on the mucous membrane, 
it merits trial in a variety of diseases." Dr. Alex. Bennet in 
1874 published in the British Medical Journal of April 18, the 
results of his observations of experiments conducted upon more 
than one hundred animals. He was about the first to conduct 
any large number of experiments with the alkaloid. His con- 
clusions were that: (1) Cocaine is a powerful poison, inducing 
a series of symptoms affecting the nervous, respiratory, circu- 
latory, and vaso-motor systems, which terminate, if the dose be 
large enough, in death; (2) In small doses, cerebral excitement 
not followed by coma, and partial loss of sensibility; (3) In 
large doses it produces cerebral excitement, complete paralysis 
of sensibility, tetanic spasms and death ; (4) It paralyzes the 
entire posterior column of the spinal cord, — cUao the entire system 
of peripheral sensory nerves,— but the anterior columns of the 
cord and the peripheral motor nerves are not paralyzed; (5) It 
does not produce muscular paralysis; (6) It usually produces 
contraction of the pupils; (7) It produces an increase in the sal- 
ivary secretion. Dr. Isaac Ott experimented in 1876 with 
internal administration and obtained similar effects, except 
that he noticed pupillary dilatation, Schroff in 1862 made the 
first experiment upon man, and found that large doses produced 
vertigo, lassitude, slight deafiiess, disturbance of memory and 
of co-ordination of tnought. Froumiiller (1863) in his exper- 
iments showed that cocaine when given in large doses produced 
sleep. He regarded it a narcotic having a primary stimulat- 
ing effect upon the brain very similar to that produced by can- 
naois indica. In the same year Floss reports {ZeiUchr. Chir,, 
222) the case of a druggist, who took about twenty-two grains 
of cocaine. For a number of hours he slept, but awoke with 
severe gripings, burning of the throat and mouth, and thirst. 
His stomach would retain no liquid. He had vertigo and a 
sense of feebleness, but the heart's action was not disturbed 
and his mind remained clear. Froumiiller got no marked 
results from internal administrations of one-half to five grains, 
and Floss' case shows that the quantity necessary to produce 
death must he very large. Moreno, as long ago as 1868, dis- 
covered that injections under the skin affected sensation so as 
to destroy reflex excitability, and Van Aurep in 1880 found 
that hypodermic injections destroyed sensibility of the skin. 
This experimenter was the first to apply cocaine to the eye. He 
used a solution containing one-half a milligramme to the con- 
junctiva, and noticed the temporary dilatation of the pupil, but 
made no note of the temporary insensibility. 

As a remedy it has recently been recommended as a nervine 
and stimulant. Dr. Aschenbrandt speaks highly of cocaine as 
a stimulant, especially in cases in which there is great physical 
weakness produced by such diseases as diarrhoea, dysentery, 



HISTORY AND CLINICAL US£8 OF COCAINS. 23 

etc. Dr. Fleische, of Vienna, from very recent experiments, has 
found that cocaine in hypodermic injections is of enormous 
value in the treatment o^ the morphia habit. 

The effective dose of the muriate of cocaine (Merck) for the 
adult is about one grain: yet Fleische in his investigations used 
an aqueous solution in doses as high as seven and a half grains 
a day. 

When a dilute solution of cocaine is iniected under the skin, 
it produces first a feeling of heat, at the place of injection ; this 
soon passes off and the part becomes red and insensible, and in 
about thirty minutes all effects have disappeared. Its effect 
upon the system is to increase the functions of the body. Its 
stimulating effects are more invigorating than those produced 
by alcohol. It acts upon the nerve centres, and upon those of 
the cerebrum more than those of the medulla oblongata and the 
cord. It has been made use of with some success in cases of 
melancholia. It rapidly restores the tone of the stomach when 
destroyed by alcoholic excesses. It has been found valuable in 
atonic weakness of the digestion, and nervous disorders of the 
stomach ; in phthisis, in exhaustion from fevers and other con- 
suming diseases. 

Effects on the Eye. — According to Dr. Knapp {Medical Recordy 
October 25, 1884), a local application of a two per cent solution 
has a ^sitive and pronounced mydriatic effect. Tendon of the 
globe, if changed, is diminished. "The diminution of sensibility 
in the cornea and conjunctiva varies in degree in different indi- 
viduals. * ♦ * TjjQ range of accommjodaiion is short- 
ened by moving the near point from the eye, the far point not 
being appreciably influenced." In making operations under its 
use Dr. Knapp found sensibility blunted, but not abolished. In 
a later communication {Medical Record^ December 13, 1884), 
Dr. Knapp reports the enucleation of an eyeball under anses- 
thesia from injecting cocaine into the post-ocular cellular tis- 
sue, and so successful was the trial that he is convinced that 
this operation can be included in the application of the alka- 
loid ; and regards it pre-eminently useful and of assistance to 
the operator in every step of cataract operations, but more par- 
.ticularly in the cleansing and final aajustment of the wound. 
Dr. Roosa in the same journal reports operations made upon 
the eye under the influence of muriate of cocaine. Some pain 
was felt in all the cases and in several sensibility seemed but 
little diminished. Drs. Agnew, Moore, and Minor, made early 
reports {Medical Record^ October 18, 1884), of the use of a two 
per cent, solution in operations. The ansesthetic effect was 
marked, and in the hands of each operator the results were suc- 
cessful. Dr. William Oliver Moore, of New York, regards {Med- 
ical Record^ November 8, 1884) the medriatic effect of cocaine ^ 
valuable contribution to the list, as ophthalmoscopic examina- 
tions can be made without the inconvenience of atropine. In 



24 HIBTORY AND CLINICAL USES OF COCAINE. 

operations about the eve Dr. Thompson, of Indianapolis, does 
not report {Journal of Ike American Medical AssodoUion, Decem- 
ber 20, 1884) as favorably as many others. Nearly all his 
patients complained of pain. In several the operations had to 
be stopped, and the patii^nts put under ether. In his opinion 
the anaesthetic property of the alkaloid has been exceedingly 
overrated, and tnat many of the cases that have been reported 
as successful would have done almost Si» well had it not been 
administered. Dr. Thompson regards it superior to all other 
medriatics for examination of the fundus of the eye, and men- 
tions that it overcomes the resistance of the orbicular palpebra- 
rum, making its use desirable in cataract extraction, and sug- 
gests applications be used in tonic blepharospasm. Dr. H. W. 
Olin, of Chicago, found it useful {Chicago Medical Times^ Decem- 
ber, 1884) to relieve the spasm of the orbicularis, in a case of 
severe burn on the cornea. Dr. Cocks, of New York, testifies to 
cocaine filling the requisits of a complete local ansesthetic, 
except in cases of acute inflammation. Dr. Riley, of New York, 
reports {Medical Record^ December 13, 1884) two failures with 
cocaine. Two attempts, with an interval of three days, were 
made in a case of granular lids with intense pannus, without 
''approximating a condition of anaesthesia. " The other case 
was a lad who had had a perforating ulcer with prolapsus of 
the iris. Applications of a two per cent, solution produced no 
effect. 

Clinical Use in the Nasal Paamyes, — Dr. F. H. Bos worth, of 
New York, is the first to mention {Medical Record^ November 
15, 1884) an effect which, in the treatment of nasal affections, 
will prove as valuable as the anaesthetic power of cocaine. He 
observed that when a two per cent, solution is applied to the 
congested and erected mucous membrane of the nasal passages, 
the puffed tissues become rigidly contracted, expelling all the 
blood from the venous sinuses, and causing the erectile tissue 
to collapse, the membrane cling closely to the turbinated bones 
which then become very distinct in outline. The same effect 
was observed in every case and to come on in a few seconds; 
the sinuses becoming entirely depleted in about three minutes. 
The intense turgescence of the venous sinuses, which always 
follows the introduction of instruments or the application of 
caustics, permanently subsided upon bathing the membrane 
with the solution. This action was so uniform and beneficial in 
the "stuflBness" of coryza and hay fever, that Dr. Bosworth 
regards cocaine a therapeutic agent of inestimable importance: 
(1) To control the exacerbation of hay fever; (2) To relieve 
the most distressing symptoms of an acute coryza and curtail 
its duration; (3) To control the painful and distressing reaction 
which results from the use of caustics or instruments in the 
nasal cavity; (4) To completely empty the venous sinuses of 
tb^ p^^al mucous membrane and thereby afford a thorough 



HISTORY AND CLINICAL USK8 OF COCAINE. 25 

ocular inspection of the cavities; (5) To largely eliminate from 
our min^r operations in the nasal cavities the troublesome 
hemorrhage which so often occurs and to control epitaxis 
from whatever cause. Dr. Ingalls regards this action almost a 
specific for the relief of the "stuffing up," caused from colds, 
hypertrophic catarrh, and hay asthma, and for *' throat deaf- 
ness," which is due to the swelling of the membrane lining 
the Eustachean tubes. 

Dr. Stuky, of Lexington, Kentucky, {LouisvUle Medical News, 
November 22) removed nasal and oral polypi, the patients 
making no complaint of pain. The removal of naso-pharyn- 
geal fibroma, nasal mucous polypi, section of nasal septum, 
and other operations of nose are reported {Journal of the Ameri- 
can Medical Associaiion, November 23, 1884) by Dr. Ingalls, of 
Chicago. In most of the operations the patients experienced 
but very little pain. He noticed that when the solution was 
applied to the swollen mucous membrane covering the tur- 
binated bones, it caused prompt and rigid contraction of 
those tissues. Dr. Jarvis, of New York, gives {Medical Record, 
December 13) his experience with cocaine in intra-nasal sur- 
gery, with report of cases, and concludes: (1) Cocaine is useful 
in intra-nasal surgery as a local ana^thetic, for the removal of 
deep as well as superficial tissue abnormalities ; (2) Repeated 
applications are required for the removal of the deeper struc- 
tures, the time requisite for anaesthesia always being shorter 
after the first effect has been obtained ; (3) By promoting quiet, 
and preventing secretion, hsemorrhage, and sneezing, it facilitates 
the employment of cutting instruments within the nasal cavity. 
Dr. Charles E. Sajous, of Philadelphia, was disappointed {PhU- 
addphia Medical News, December 20, 1884) in cocaine as an 
anaesthetic for nasal operations. Of fourteen cases in only two 
did it show marked effect. He noticed that when applied for 
intra-nasal operations, if the mucous membrane was distended 
it in a few moments collapsed, corroborating the observations 
of Dr. Bosworth. 

In Dentistry, — Dr. Howe in the Dented Cofnios for December 
speaks enthusiastically of his experience with hydrochlorate of 
cocaine in filling teeth. The application of a two per cent, 
solution in the cavity of a tooth will reduce the sensitiveness 
of the dentine so as to permit cleaning and filling with practi- 
cally no pain. In his experience, Dr. Hall, before having a 
tooth cleaned and filled, the dentine of which was extremely 
sensitive, had eight minims injected at the infra-orbital for- 
amen, which produced anaesthesia not only of the cheek, upper 
lip, and all parts supplied by the infra-orbital nerve, but the 
incisor teeth, showing that the effect extends centrally as well 
as distally along the nerve. Dr. Husted, who was associated 
with Dr. Hall in his investigations, obtained similar results in 
a medical student and in Dr. Hall, by introducing the needle 



26 HISTORY AND CLINICAL USES OF COCAINE. 

SO as to reach the inferior dental nerve. Hard blows upon the 
teeth produced no sensation. Dr. Weld, of New York, found 
(Medical Record, December 18, 1884) four grains of cocaine to 
the drachm of spirits of peppermint, diminished the sensibility 
of the gum and rendered tne exposed pulp painless. In the 
same journal Dr. Shears writes that he did not find the pain ot 
extracting teeth materially reduced from applications of a two 
per cent, solution to the gum. 

GenitO'Urinary Organs, — In genito-urinary procedures Dr. 
Otis, of New York, writes {JVew York Medical Joumai, Decem- 
ber 6, 1881) very enthusiastically. In a very hypersesthetic 
patient, upon whom no instrument could be passed on account 
of intense pain produced, preparatory dilatation and the oper- 
ation of litholapaxy were performed without pain after the 
injection and retention for fifteen minutes of fifteen drops of a 
two per cent, solution. He divided a long dense stricture, 
without the slightest pain during or subsequent to the opera- 
tion. Dr. Otis thinks the greatest good will come from the use 
of cocaine in cases of irritability of the deep urethra associated 
with prostatic disease. The pain and spasm are removed and 
an easy passage of the instrument obtained. He has had very 
satisfactory results from the use of a four per cent, solution in 
almond oil as a lubricant for urethral instruments. The same 
satisfactory results were obtained after examinations and oper- 
ations upon the irritable anus and rectum; a very extensive 
ulcer of the rectum was cauterized in a feeble old lady without 
the least expression of pain from the patient. Dr. Kelley 
reports its use in fissure in ano. The patient, aged fifty years, 
for two weeks had sufiered all the pain to which such victims 
are liable. Examination, which produced intense suffering, 
revealed an ulcer one-half an inch long. The touch of finger 
unbearable and compared to the burn of a red-hot iron. Three 
applications every two minutes of a four per cent, solution 
made the part insensitive and the ulcer was cauterized with 
nitrate of silver without producing any pain. Dr. Joseph Bat- 
telheim used (PhUadephia Medical News. December 20, 1884) 
one-half grain of the hydrochlorate in suppository of cocoa but- 
ter, for persistent rectal and vesical tenesmus in a patient aged 
seventy-four years, with perfect success; the good result contin- 
ued twenty-four hours. Dr. Knapp testifies, from experiments 
on his own person, to the anaesthetic power of cocaine on the 
urethral mucous membrane, and is convinced that it will prove 
most beneficial in uro-genital surgery, by rendering surgical 
procedures upon these parts painless, and by destroying reflex 
phenomena. Dr. Williams writes (New England Medical 
Monthly, December, 1884) that an application of cocaine by 
means of a pledget of cotton placed against the os relieved an 
aggravated case of painful menstruation. The editor of the 
journal containing this report, gives a similar experience with 



i 



HISTORY AND CLINICAL USES OF COCAINE. 27 

• 

the drug in dysmenorrhoea. Pain soon subsided and the menses 
appeared' in about four hours. 

In Oynsscological Operations. — ^The first report (Medical Rec- 
ord, November, 1884) of the use of hydrochlorate of cocaine in 
gynecology is made by Dr. Polk in two successful operations 
upon the cervix uteri. In these operations it was observed that 
the first appearance of blood upon the cut surfaces was re- 
tarded. Dr. Kelley before operating for lacerated cervix, found 
all sensation abolished in seven minutes from application of an 
eight per cent, solution made by saturating a pledget of cotton 
and placing it against the os. The operation lasted for two 
hours and no complaint was made except when sutures were 
introduced. The application was not repeated. Dr. Doughty, 
of Augusta, Georgia, (Medical Record^ December 13, 1884) 
reports the use of hydrochlorate of cocaine in an operation for 
vesico-vaginal fistula. No complaint of pain was made by the 
patient from the paring until the expiration of sixteen minutes 
the application was renewed when the operation was finished 
without pain. While the parts were insensible the hsemorrhage 
was very slight, but on return to sensitiveness the loss of blood 
was decidedly increased. 

Hypodermic Use. — Repeated hypodermic injections of six 
minims of two per cent solution ever}' five minutes, until forty- 
eight minims were used, produced in Dr. N. J. Hepburn 
(Medical Record, November 15, 1884), beside such stimulating 
symptoms already mentioned, a general impairment of cutan- 
eous sensibility, a feeling as if walking on cushions, and a 
sensation as if something spongy were interposed on grasping 
an object. Dr. R. J. Hall, of New York (New York Medical 
Journal, December 6, 1884), injected subcutaneously six minims 
of a four per cent solution made by Parke, Davis & Co., in 
various regions of his body. Each injection was followed in a 
few minutes by complete loss of sensation over a greater or 
less an area extending downwards. When the solution was 
thrown into the tissue around a large nerve trunk, there was 
loss of sensibility throughoui the area of distribution of the 
nerve. There seemed to be no loss of sensation at the seat 
of puncture. Dr. C. J. Lundy, of Detroit, observed a slight 
hypersemia in all eases. The parts when incised bled more 
freely than usual. A small tumor was painlessly removed 
(New England Medical Monthly, December, 1884) by Dr. Robert 
Wier, of New York, from the forehead of Dr. J. W. Wright, 
after two hypodermic injections of six and four minims respect- 
ively around the base of the growth. 

After this somewhat extended capitulation of the various 
applications of the hydrochlorate of cocaine, it must be con- 
ceded that this alkaloid is a powerful and efficient drug. The 
suddenness with which it has risen from obscurity into a prom- 
inence not exceeded by the oldest remedy is truly phenomenal. 



28 CONDENSATIONS. 

That its anaesthetic action should not have been noticed earlier 
is also remarkable. And, now that it is known and well 
established, it is not surprising that '' over-zealous enthusiasm" 
would lead to disappointments. It does not produce the same 
results in all persons, nor should it be expected to do so. Indi- 
viduals vary greatly in the degree of pain produced from 
identical causes, and the influence of the mind plays an 
important part in the creation and abolition of painful sensa- 
tions. While it has been employed with success in nearly 
every department of medicine and surgery, the muriate of 
cocaine will continue to be a wide field for careful research. 
The results from the hypodermic use of the drug, show that 
in this direction we may expect to find its range for the relief 
of pains much more widely extended. The role it may take 
in the control of inflammatory processes and in haemorrhage, 
through its effect upon the vaso-moter system, is to be deter- 
mined. 



CONDENSATIONS. 



The beginning of the new volume finds many subscriptions 
due. Will each subscriber see that he starts the year " square? " 

Dr. Formad says that no pathologist believes diphtheria 
and croup to be identical diseases, but merely that the exudation 
of the two diseases are the same. While similar in composition 
the exudation is not the same in its relation to the mucous 
membrane; the croupous false membrane lies upon, while the 
diphtheritic extends down into, the mucous membrane. The 
croupous membrane can be readily separated from the mucous 
coat, while diphtheritic membrane is separated with difficulty, 
and leaves a bleeding surface. 

Mr. Harrison, surgeon of the Royal Infirmary, Liverpool, 
relieves the difficulties arising from enlargemeat of the prostate 
by making a straight passage. An operation is made some- 
thing like that of median lithotomy, and afterward a straight 
catheter is worn for several weeks, until the healing process is 
complete around the catheter, which is then withdrawn, and 
the external wound permitted to heal up. For a sufficient time 
longer a catheter is passed daily through the urethra. The 
bladder itself is washed out sufficiently often by a weak, warm 
carbolized water. 



Alexander Faulkner, of the Indian medical service, 
brings to notice a point in the treatment of cases after the 
operation of lateral lithotomy, namely, that of continually 
keeping the patient lying on his abdomen after the operation. 
He has practiced this procedure for some time and says: ^'Al- 



CONi>BNSATiON6. 29 

though this mere position may seem at first an apparently 
trivial detail, yet I consider it is of importance in expediting 
the healing process of the perineal wound, as by its means the 
urine has a tendency to pass more through its natural course 
into the urethra when expelled from the bladder, instead of 
continually permeating through, and, consequently, irritating 
the open perineal wound." 

Santonins often fails as a paracide because it does not come 
in direct contact with the lumbrici, from the mode of adminis- 
tration. Kuechenmeister has shown that lumbrici lived in a 
mixture of albumen, santonine and water, but they died in a 
few minutes in an emulsion of santonine and oil. Santonine 
powder or troches are, therefore, not a good way of administra- 
tion, for the santonine bein^ soluable is mostly absorbed in the 
stomach. When given in oil it is not taken up by the stomach 
and slowly absorbed by the intestines. Given with castor oil 
it is not disagreeable and has the advantage of being given with 
the cathartic that is usually used after the administration of 
santotiine in any form. 

The following tribute to American medical schools was paid 

by Lawson Tait, in a lecture recently delivered while in this 

country: "In my early days the medical education of a British 

youth was not considered complete unless he had made a tour 

of the schools of France and Germany, and, like others, I felt 

of myself as was said of Proteus : 

"Twould be a great impeachment to his age 
In having known no travel in his youth.' 

But I now wish that the time and money spent had been 
directed to the western instead of the eastern continent, and I 
now venture to predict that ere long it will be to the medical 
schools of America rather than to those of Europe that our 
students will travel, as did the apprentices of old oefore they 
settled down to the serious exercises of their craft." 



"Death of a physician from chloroform," is the heading of 
an editorial in the Weekly Medical Review^ of November 8, which 
notes the death of Dr. C. M. Whiting, of Ogle county, Illinois. 
It is mentioned here, not to chronicle a news item, but to avail 
ourselves of the opportunity to speak of the practice with many 
physicians to self-administer inhalations of chloroform, for 
slight painful ailments. It is apparently in this way that Dr. 
Whiting met his death. His body was found in his office on a 
couch with his hand and a handkerchief to his face, while on 
a table at his side, stood a corked bottle containing chloroform. 
If chloroform has once been resorted to for the relief of pain, 
the habit of frequent personal inhalations is easilv acquired 
by the physician. To the jaded, over-worked practitioner, the 



30 *KW i>UtolCATtONS. 

temptation is great to obtain a few minutes or an hoards rest 
and sleep through the rapid and quieting influence of chloro- 
form. But with any one who falls into this dangerous habit, it 
is only a question of time, and a probable very short time, 
until the coroner's jury will have a verdict of" death from some 
cause unknown to the jury." The administration of chloroform 
will kill, and "if facts do not convince, no amount of admoni- 
tion will." 



NEW PUBLICATIONS. 



DISEASES OF THE THROAT AND NOSE. INCLUDING THE 
PHARYNX, LARYNX, TRACHEA, (ESOPHAGUS, NOSE, AND 
NASO-PHARYNX. By MoreU Mackenzie, M. D.. London, Con- 
8iiltlng Physician to the Hospital for Diseases of the Throat, Ij«c- 
turer on Diseases of the Throat at the London Hospital Medical 
College, and Corresponding Member of the Imperial Royal Society 
of Physicians of Vienna. Volume II : Diseases of the (Esophagus , 
Nose, an<l Naso-Pharynx, irith Index of Authors and Formulae for 
Topical Remedies. Illustrated; octavo; five-hundred and forty 
pagep. Cloth, $3.00 ; Leather, $4.00. Philadelphia: P. BUkiston, 
Son & Co., 1884. 

The publication of this volume fulfills the promise made by 
Dr. Mackenzie, when the first volume was published four years 
ago, and completes his great work on *' Diseases of the Throat, 
Nose and adjacent parts." The first volume, from its real inher- 
ent worth, immediately became a work of authority and the 
standard text-book on the diseases of the pharynx, larynx, and 
trachea. The laryngoscope, for the last few years, has become 
an instrument of common use, and diseases of these regions, 
that were formerly theorized upon, are now intelligently diag- 
nosed and treated, and the profession is ready to appreciate and 
profit from such an exhaustive and practical treatise as the one 
before us. 

Those who have become familiar with the first of these vol- 
umes, will know the merit of the second, when they are informed 
that it has the same plan of arrangement ; all details and refer- 
ences are compiled with the same care and thoroughness as its 
predecessor. 

This volume is divided into three sections, and treats respec- 
tively the diseases of the oesophagus or gullet, the nose, and naso- 
• pharynx. These sections are divided into chapters, each one 
dealing with a particular disease, which is systematically 
described, giving a concise definition of the disease; a brief 
history, the etiology, symptoms, diagnosis, prognosis and treat- 
ment, and illustrative cases. 

The first section deals with the oesophagus, and to the aver- 
age physician it will probably prove to be the most entertain- 
ing as well as important from the amount of information he 
will find pertaining to this formerly unnoticed and inaoces- 



NEW PUBLICATION. 31 

sible tube. New methods of diagnosis have greatly enlarged 
the knowledge, and many new facts have been obtained respect- 
ing the healthy and diseased condition of this region. 

The methods of examination during life are by aulcultation, 
by percussion, by palpation, and by direct inspection. Aus- 
cultation is the method by which the most satisfactory infor- 
mation is derived, and the investigation of the sounds heard 
during the act of deglutition, and their proper interpretation, 
have given much light upon formerly unknown conditions. 

The second section is devoted exclusively to the nose. The 
anatomy of the part is first ^iven, the three methods by which 
the nose can be examined, is detailed with most minute and 
specific instructions; and cuts and full description.^ of all the 
instruments used in examining in exploration, and for opera- 
tions are given. The treatment given for each of the various 
forms of nasal catarrh is practical, and his methods, drawn 
from a long, and most extensive experience, cannot be other- 
wise, than of great service to all who have occasion to treat 
these very common forms of disease. 

Nasal growths are qiassed as non-malignant and malignant. 
In the treatment of the non-malignant, Dr. Mackenzie gives 
decided preference to the galvanic cautery, but in many cases, 
recommends their removal by means of the forceps. The 
remaining section on naso-pharyngeal affections, is a treatise of 
inestimable value to the American physician. It is a mine of 
information to be drawn from, for a more perfect knowledge of 
the pathology of this much diseased and greatly neglected 
cavity. 

The complete work is a monument to industry and perse- 
verance, the shining qualities of the workman who erected it. 
The immense amount of care and labor that has been expanded 
upon the work, may be inferred from the first sentence of the 
author's preface: **It is now nearly twelve years since this 
work was commenced, and during that period there U scarcely 
a page that has not been written and re-written many times.^' 



BOOKS AND PAMPHLETS RECEIVED. 



SYNOPSES OF LECTURES ON OSTEOLOGY, SYNDESMOLOGY, 
AND AUGEIOLOGY. By Corydon Ford, M. D.. LL. D., Professor 
of Anatomy and Physiology, University of Michigan. Reguter 
Pablishing House, 1884. 

MEMBRANE VIRGINATATIS. By E. S. McKee, M. D., late Clinical 
Assistant to the Hospital for Sick Children, Great Ormond Street, 
London, England. Reprinted from Nashville Journal of Medicine 
and Surgery, November, 1884. 

PERMANGANATE OF POTASSIUM: ITS ACTION AND USES. By 
Roberts Bartbolow, M. D., LL. D., Professor of Materia Medica, 
General Therapeatics and Hygiene in the Jefferson Medical Col- 
lege of Philadelphia. Reprinted from the Medicai News, Novem- 
ber 22, 1884. 



32 NEW PUfeLICATIONS. 

QUESTIONS SUBMITTED TO THE GRADUATING CLASSES OF 
THE MEDICAL COLLEGE OF OHIO, FROM 1871-72 TO THE 
PRESENT TIME. Price, 50 cents. Cincinnati: Will H. Scott. 

MEDICAL EDUCATION AND MEDICAL ETHICS. By Henry 
Leffmann, M. D., D. D. S., Profenaor of Chemistry and Metalargy 
at the Pennsylvania College of Dental Surgery ; Demonstrator of 
Chemistry at the Jefferson Medical College; Secretary of the 
Medical Jurisprudence Society of Philadelphia. A paper read 
before the Philadelphia County Medical Society, September 24, 
1884. Reprinted from the proceedings of the society, with dis- 
cussion. 

ON THE DEVELOPMENT OF PHYSIOLOGICAL CHEMISTRY 
AND ITS SIGNIFICANCE FOR MEDICINE An address deliv- 
ered at the celebration of the opening of the new Institute for 
Physiological Chemistry of the Imperial University of Strassburg, 
February 8. 1884, by Professor Felix Hoppe-Sevler.' Translated by 
T. Wesley Mills, M. A., M. D., Demonstrator of Physiology, McGill 
University, Montreal, Canada. Reprinted from the Nev} York 
Medical Journal, for August 16 and 23, 1884. 

THE STUDENTS' MANUAL OF HISTOLOGY, FOR THE USE OF 
SxUDENTS, PRACTITIONERS AND MICROSCOPISTS. Third 
edition, entirely rewritten, greatly enlarged, and newly illustrated. 
By Charles H. Stowell, M. D., F. R. M. S., professor of histology 
and microscopy, and in charge of the histological laboratory of the 
University of Slichigan. Illustrated by one hundred and seventy- 
eight engravings. Octavo; three hundred and fifty*eight pages. 
Price, $3.50. Ann Arbor, Michigan : Charles H. Stowell, Publisher, 
1884. 

SURGERY: THE SCIENCE AND ART. By John Erie Erichsen, F. 
R. S., LL. D., F. R. C. S., Surgeon Extraordinary to Her Majesty 
the Queen; Ex- President of the Royal Colleflre of Surgeons of 
England, and of the Royal Medical and Chirurgical Society; 
Emeritus Professor of Surgery and of Clinical Surgery in Univer- 
sity College; Consulting Surgeon to University College Hospital, 
and to many other Medical Charities. A Treatise on Surgical 
Inquiries, Diseases, and Operations. Eighth edition, revised and 
edited by Marcus Beck. M. S. and M. B., London, F. R. C. S., Surgeon 
to University College Hospital; and Professor of Clinical Surgery 
in University College. London. Volume I: containing one thousand 
and eighty-four octavo pages, illustrated with nine hundred and 
eighty-four engravings. Philadelphia: Henry C. Idea's Son & Co., 
1884. 

MENTAL DISEASES: CLINICAL LECTURES. By T. S. Clonston, 
Edinburgh, F. R. C. P. £, Physician Superintendent of the Royal 
Edinburgh Asylum for the Insane; Lecturer on Mental Diseases in 
the Edinburgh University; Formerly Co-Editor Journal of Mental 
Science; Foreign Associate of the Societe Medico-Psychohigique; 
Honorary Member of the Association of Medical Superintendents 
of American Institutions for the Insane, and of the New England 
Psychological Society. To which is added an Abstract of the 
Statutes of the United States and of the several states and terri- 
tories relating to the custody of the Insane. By Charles F. 
Folsom, M. D., Fellow of the American Academy of Arts and 
Science; Assistant Professor of Mental Diseases in Harvard 
Medical School; Physician to Oat-Patients with Diseases of the 
Nervous System, Boston City Hospital. Philadelphia: Henry C. 
Lea's Son k Co , 1884. 



MODERATION IN EDUCATION. 33 

MEDICAL DIGEST. 



MODERATION IN EDUCATION. 



The alternate and countervailing inflaence of action and of 
reaction is as much an ethical as a mechanical law. The pen- 
dulum of public opinion is always swinging in one direction or 
the other; although the means of its excursions become lees 
and less, as the knowledge grows wider and is more intelligently 
applied. In many respects the present is a period of reactions, 
that is to say, we may congratulate ourselves that in not a few 
instances our practice in carrying out the details of modern life 
is tending to tne normal rather than diverging from it. And it 
is significant that at a time which resounds with the cr^ for 
something more than moderation in drink, there is ansing 
a demand for something like moderation in our methods of 
education. 

The parallel which might' be traced between what might be 
called educationalism and alcoholism does not, fortunately, run 
very far, but its extent is sufficient to be suggestive. Of alcohol, 
as of the modem scheme of education, it may be said that each 
has been regarded by its partisians as the elixir vUx; that both 
are capable of abuse and adulteration ; and that neither can be 
employed to advantage without the careful exercise of a dis- 
criminating judgment and of continuous watchfulness. Alcohol 
is not necessary to those in robust health; over-indulgence 
and especially a precocious indulgence in it, induces a train of 
mischief from which the whole organism, and the nervous sys- 
tem in particular, inevitably suflers. On the other hand, while 
education is the natural — we should rather say the necessary — 
complement of the physically healthy human being, its meth- 
ods, if too zealously or carelessly applied, may blunt or over- 
strain the dawning powers of the young scholar, whose mental 
development needs often to be guided and guarded rather than 
to be driven and stimulated. It is not difficult to admit, on 
theoretical considerations, that each of two such apparently 
dissimilar things as alcohol and education may have its use, 
and that each is liable to abuse: or that the heedless employ- 
ment or application of either is likely to be followed by results 
which are sure to lead in time to a demand for moderation and 
reform. 

With respect to alcohol, we have, unfortunately, only two 

Sod reasons for acknowledging the existence of excess, and 
r setting forth the virtues of moderation. In regard to the 
educational systems of the day, we stand on newer ground; 
the data at our command are derived from a shorter period, 
and are from the very nature of the inquiry necessarily imper- 
fect, but they are sufficient to enable us to form some definite 
c 



34 MODERATION IN EDUCATION. 

conclusions which are not inconsistent with the teachings of 
physiology or opposed to the general consensus of experience, 
in this matter we believe that the opinions that have been 
expressed by those members of the profession who have paid 
special attention to the subject, have been, to a considerable 
extent, misunderstood, while their opponents do not always 
appear to understand themselves. Medical men do not under- 
value education, but they regard schooling as only a part of it. 
Real education is to acquire the art of knowing, not merely to 
know. It implies all the difference between the poet and the 
parrot, between a Babbage and a calculating machine. It is 
the training of the powers of observation and of reasoning, 
with the coincident development of the physical agencies bv 
which these powers are exercised. And its value is degradea, 
and its true relations woefully misunderstood, if we rqgard the 
period for its acquisition as anything shorter than lue itself. 
For the attainment of a result so vast and intricate, it follows 
that the foundations must be sound and thorough. But these 
foundations are laid in the training of young brams and bodies 
whose powers are just budding into activity, and at a time of 
life when the whole energy of the organism is often hardly 
taxed by the demands of mere existence and growth. Under 
these circumstances is there not need for care; is there no risk 
of harm, no liklihood of serious mischief being suffiered, and 
of the real value of the object in view, being overlooked? Is 
it remarkable that those whose business implies familiarity 
with disease should be the first to detect a mischief which is 
greatly a question of degree, and should be the most earnest in 
warning against evils which others are unfortunately less able 
or less willing to appreciate? Surely it is unfair to blame the 
doctors for attempting to give advice in time — ^as though the 
signal-man should show his danger lamp only when the colli- 
sion has actually occurred; and it is, to say the least, unbusi- 
nesslike to treat such warnings and advice either in a purely 
partisan spirit or with a perfunctory heedlessness which would 
not be displayed in relation to any other business of life. The 
allegation of over-pressure in connection with board and elemen- 
tary schools has been established in comparatively few instances. 
Had it been otherwise, the conscience of the profession would 
have been less clear, for it would have been proof that there 
had been gross oversight or criminal silence respecting a great 
evil. Whether the charge has in -all cases been investigated or 
dealt with fairly is another question. 

After a perusal of the Educational Blue Books for 1883-84, 
the existence of "over-pressure," to some extent among the 
scholars in elementary schools must be admitted, from the 
reports of the inspectors themselves; and we contend that 
whether this over-pressure be due solely to the burden of an 
excessively exacting code, or to the mistaken zeal, or unwise 



MODERATION IN EBUOATION. 86 

methode, or reckless ambition of teathers, or the straggle of a 
small school to make both ends meet by earning grants on the 
extra ''class subjects," or to the carelessness and ignorance of 
the managers, or, lastly, to the under-feeding and other phys- 
ical disqualifications of the school children, wherever and 
whenever it exists, the medical observer is bound to notice it, 
and to protest against a system which allows it. The question 
of remedy is no doubt difficult enough, but his first business 
is to see that the evil does not go undetected. 

It is not to be supposed that educational over-strain is con- 
fined to the scholars and pupil-teachers in elementary schools, 
like every other organ of the body the brain requires exercise, 
and is distinctly benefited by work proportioned to its capabil- 
ities. But give to the child who has such a brain — and a con- 
science — over-much work of one sort to be done within a lim- 
ited timOj or work of different kinds under the same conditions, 
and you import into the problems the new and all-destructive 
&ctor, worry. Worry of this kind appears, on analysis, to con- 
sist in the endeavor to do or to think of two or more things at 
once, so that one part of the brain is not at rest while another 
is working, and there is no chance of " tum-and-turn-about " in 
its labors. Hence, while worry is doubtless to some extent 
imported into the mental difficulties of the board school chil- 
dren, it is much more common and more wearing amongst the 
more finely strung, the more conscientious, and the more ambi- 
tious children of higher-class schools. Mrs. Garrett Anderson 
has recently pointeaout that in the middle-class schools — ^and 
especially those for girls — ^the temptations to, and the existence 
oi^ over-pressure are considerable; and she rightly indicates 
that it is the mothers who should exercise the observation and 
supervision required for detecting, as they possess the power of 
checking, the evil in its earliest stages. This aspect of the 
question loses none of its gravity when we reflect that the 
school girls of one generation become the mothers of the next. 
The nervous organization and the nervous failings of the 
mother tend largely to be transmitted to her offspring; and 
there are but two serious reasons for dreading lest the preco- 
cious stimulation and premature exhaustion of nervous energy 
which educational fashion is now apt to entail upon so man^ 
school girls should be visited with more dire results upon their 
children. 

The whole subject is one of national importance. It deals 
so directly with our position amon^ the nations of the future 
that it cannot be dismissed lightly, unconsidered. It com- 
presses problems so difficult and involved that it cannot be 
settled off-hand, and it is capable, if rightly dealt with, of 
yielding results so grand and gratirying as to be well worthy 
of the ungrudging expenditure of the time, the labor, and the 
money, which are needed for its adequate solution. National 



86 CHLOROFORM AND CROTON OIL FOR TAPE-WORM. 

feeling is being aroused, and the question is beginning to be 
asked whether, in carrying out what was confessedly a novel 
departure in state education, we have not been too exacting in 
our demands, too stringent in the application of generalizations. 
Let the evidence be collected and discussed fairly and dis-* 
passionately, as becomes the subject. Let us be grateful for 
warnings whose value must be proportionate to their timeli* 
nees, and still more gratefal if the fears to which Uiey have 

fiven rise should turn out less serious than had been supposed, 
f mistakes have been made, let us acknowledge them and see 
to their repair, bearing in mind that repentance is much less 
bitter, as it is less costly, than remorse. 

In this matter, as in the great ''drink question," the object 
of the profession has been to avoid extremes. We would not 
shut up the schools any more than we would advocate drunk- 
enness; but we would not hold silence while a well-fed child 
was being overworked, or an ill-fed one worried into disease, 
any more than we should refuse to prescribe alcohol as a med- 
icine for a patient whom we believed to need it; and both as 
regards mental work for the child and the use of alcohol by 
the adult, we preach the golden mean of moderation. What 
moderation consists in is a question which can only be decided 
on the individual merits of each case; but to do so is not im- 
possible. It involves the outlay of some trouble and reouires 
the habit of looking things honestly in the face; and, not oeing 
a fixed quantity, from time to time it will require a certain 
amount of readjustment. But most things in this world involve 
trouble in the doing of them* and no good work can be accom* 
plished without it. — London Medicai Times. 



CHLOROFORM AND CROTON OIL FOR TAPE- WORM. 



Dr. Bernard Persh, according to the Medical and Suirgiecd 
Reporter, has most satisfactory results in cases of tape-worm 
with chloroform and croton oil. He suspends one drop of 
croton oil and a drachm of chloroform in one ounce of glycer- 
ine; this to constitute one dose. The medicine is best given in 
the morning before breakfast, and no preparatory treatment is 
required, except half an ounce of Rochelle salt on the evening 
preceding the removal. The preliminary laxative is not neces- 
sary to affect a cure, and it was omitted in several cases; but its 
administration facilitates the examination of the evacuations, 
prevents breaking up the worm by hard faeces, and allows the 

Earasite to pass more quickly through the intestines after 
ecoming detached. The medicine is not unpleasant to take, 
and acts auickly. If any intestinal irritation is caused it may 
be controlled with bismuth and opium after the expulsion of 
the worm. 



MODERATE DRINKING AND TfiETOTALIBM. <37 

THE LANCET ON MODERATE DRINKING AND TEETOTALISJtf. 



At the recent health exhibition in London the subject of 
intemperance was discussed, and the use of alcoholic liquors 
condemned in no measured terms. The Times thereupon pub- 
lished a leading article defending moderate drinking, and stated 
that teetotalers are persons of inferior physical development, 
and so far as they can be judged by facial expression, not 
^'remarkable for intellectual power," the best work of the world 
.beinff done by the moderate drinkers. On the whole it was 
xx>pcTuded that teetotal societies do very little good, and a great 
deal.of harm. The Lancet in commenting upon this, witnout 
4it#mpting to defend the dogmatism of temperance reformers, 

" We oannot much approve of the article in our contempor- 
•aryy.but it is rather of its tone and spirit, than its substance, 
ttiat we have to complain; rather with its scant and reluctant 
praise — its actual dispraise — of men with a great cause and 
good motives, than with its scientific propositions that we have 
to quarrel. The world is not so much in danger of neglecting* 
to take a proper amount of alcohol, that it needs three or four 
^lumns of ingenious argument to prevent it falling a prey to 
indigestion and nervous exhaustion from drinking water alone. 
But the excuse for such writing would be less if there were a 
litUe more reasonableness and temperance on the part of those 
who seek to abate the national consumption of alcohol. Their 
€ase is by no means contemptible, logically and medically, as 
the writer referred to above would make out. There are some 
very good looking fellows among them; they are not by any 
means intellectually contemptible; they live quite as long as, 
if not longer than, other people, and escape many diseases that 
Affect others, though they may have their own liabilities. They 
are good workers. There may not yet have been a teetotal 
Shakespeare or Milton — there has not been time; but much of 
the best work of the world nowadays is done by men who 
either do not use alcohol, or use it in such quantities as to be 
imperative physiologically or pathologically. And the common 
work of the world is done well by abstainers; they are indus- 
trious, reliable, healthy. According to Lord Wolseley, they 
make good soldiers. Sir William Gill has said that * it is one 
of the commonest things in our society for people to be injured 
by drink without being drunkards, it goes on so quietly that 
it is very difficult to o&erve. To the professional eye the effect 
is perfectly marked and distinct.' Manv other eminent men 
have given similar testimony. So that, there is an amount of 
drinking deemed moderate by society, which, in the opinion of 
judges, IS very injurious to the liver, lungs, the nervous centres, 
etc. Further, the actual impression made by the teetotal school 
on public opinion and social habits is considerable, so that sen* 



38 NASAL POLVPI — FUNCTION OF THE SPLEEN. 

Bible men do not take stimulants in the quantity they used to 
do, or on an empty stomach and without food. No doubt 
much of this is. due to sounder medical science and to the 
extreme moderation of medical prescription and example. But, 
part of it is due to teetotalism and to religious eSbrte to pro- 
mote sobriety, which it should be thedesire of every one to 
second, the more so as there is still a frightful amount of ignor- 
ance abroad aa to the impuuity with which alcohol, even in 
strong froms, may be taken into an empty stomach. A physi- 
ologist may still be shocked every day in a restaurant or a rail- 
way refreshment room — of course physiologists never go into 
public-houses — by iseeing young men order and toss off without 
thought nnd without food, glasses of spirits, more or less raw. 
He knows how inridliblr and how quickly that leads to mis- 
chief. But for evils and follies like tnis there is room for com- 
mon protest oml uffort, apart from intemperate doctrines of 
teptotaliam on thf one hand, and too easy disparagement of 
those who hold ihem on the other." — Medical limes. 



\ 



THKATMENT OF NASAL POLYPI. 

As a vnluabli' contribution to the therapeutics of this 
onpleasnnt con^liliun we are glad to notice that Dr. Richanl- 
son (in the Andi-]'i'"i) recommends the use of sodium ethylate 
in the treatment of naaal polypus. The caustic agent is 
applied by menus iif a probe made of soft cotton wool twisted 
into shnpe mi ttic )ji)inta of a pair of forceps. This cotton probo 
is saturated with llie ethylate and then plunged into the sub- 
stance of the iinlypus. On removing the cotton itcommonly 
happens that tlie patient can expel the whole mass of 
destroyed polyjuis. in a semi-fluid form, by blowinff the nose 
aharply. A Becoii'! application ought to be made with a view 
of destrori"t; the huge of the polypus. The mode of action is 
■aid to be suffieienlly clear. The ethylate is decomposed by 
contact with tlic water of the polypus into caustic soda ana 
alcohol — liie hitttr <;oagulates the albuminoids, and the former 
acts as a powerful e.austic. With the exception of some bnm- 
Hia Main, no iiii pleasant effects seem to follow the use of this 



i 



Tin: FUNCTION OP TBE SPLEEN. 






The spleen may be extirpated from an animal without 
--nftreotiy producing any special disturbance; and tboagb, 
£^its periodiefil engorgement during digestion, it has been 
^^oeed to form a functional part of the digestive apparatna, 
*yjje by no means certain of its functions in the body. 

0^^»n nomo^ fcrward in support of an old view of Schiff's, 
'se relation between the trypsin, or proteid 



MERCURY IN THE INTESTINAL CANAL. S9 

ferment, producing power of the pancreas and the activity of 
the spleen. The author makes an infusion of the pancreas of a 
fasting dog, and finds that it has little or no power to digest 
proteids, but if the same pancreas be extracted after mixing 
it with part of the swollen spleen taken from an animal in 
fall digestion, it has very great power of artificially digesting 
proteids. 

The conclusion arrived at, from varied experiments, is, that 
during the active, swollen condition of the spleen in digestion, 
there is produced in it a special ferment, which being trans- 
ported by the circulation to the pancreas, there sets up changes 
which result in the partial conversion of the store material of 
the pancreas into the active proteolytic ferment, trypsin.— 
American NaturcUist, 



THREE POUNDS AND TWO DRACHMS OF MERCURY CARRIED 
IN THE INTESTINAL CANAL FOR THIRTEEN DAYS. 



Mr. A. K. Young records {British Medical Journal) a case of 
intussusception in which he had in vain tried a water pressure 
per rectum, the pressure corresponding to a column of water 
thirty feet high. He then introduced a tube into tlje stomach 
and with the aid of a funnel he poured in two pounds of mer- 
cury. This was at 6 p. m.. May I. At 10 p. m. one pound and 
two drachms more were introduced. This was the whole of 
the mercury in the hospital. The patient was sent to bed and 
directed to lie on his right side for an hour, and after that ta 
study his own comfort. 

The two following nights were reported as having been 
passed quietly. On the 10th, he was vomiting everythmg he 
took and no passage through the obstruction had been effected* 
On this day be sent for his horse and cart to leave for home. 
Mr. Young made no objection to the plan, but rather encour- 
aged it, with the hope that the jolting would facilitate the pas- 
sage of the mercury. He started for home at 6 p. m. of the 
same evening. On the day after small quantities of mercury 
and small faecal discharges occurred daily. On the 20th a large 
fsBcal discharge occurred, but it was not until the next day, 
the 21st, or nearly thirteen days after its introduction into the 
stomach, that the great bulk of the mercury was evacuated. 

Mr. Young says: "Neither during the time it was blocked 
up in the abdomen, nor at any time after its discharge, was 
there any symptom, constitutionally or local, to indicate its 
presence. Mr. Young discusses the probable mode of action of 
the mercury under the circumstances. The explanation must 
necessarily be incapable of demonstration, but the interesting 
tBLCt remains that the patient recovered after the diligent use of 
all the regular classical means, short of abdominal section, had 
been triea in vain. 



40 SPREAD OF DIPHTHERIA — EFFECTS OF MERCURY. 

THE SPREAD OF DIPHTHERIA. 



A paper on diphtheria read by Dr. A. Jacobi before the 
Society of the County of New York, closed with the follawiog 
enmmarization : 

There is probably no spontaneous origin of diphtheria aogr 
more than there is a spontaneous origin of cholera or scarlatina. 

Diphtheria is contagious. Severe forms may beget severe or 
mild lorms. Mild cases mav beget mild or severe cases. 

What has been called follicular tonsilitis is mostly diph- 
theria. It is seldom dangerous to the patient, as the tonsils 
have but very little lymph communication with the rest of the 
body. But it is contagious. 

This form is frequent in the adult, in whom it loses nothing, 
however, of its contagiousness. 

Diphtheria in the adult proves dangerous to the community 
mostly because it does not restrain the patient from commum* 
eating the disease. 

It is apt to last long, firstly, because most cases occur on a 
surface covered with pavement epithelium (tonsils); secondly, 
because of the constant exposure and neglect on the part of the 
patient. Even without it, diphtheria may last weeks and mor^; 
with it, it is subject to sudden relapses. As long as it lasts it 
is contagious. 

As diphtheria is but a mild affection in many adults, who 
disregard it and frequently do not mention its existence, pain 
in swallowing and moderate malaise being the only symptoms, 
the question of transmission by means of clothing, etc., on the 
part of third persons is capable of becoming more difficult to 
answer than it ever was. Many a case which nas been believed 
to be thus carried is probably one of direct contagion from a 
patient to a second person, from this second to a tnird. — Nem 
York Medical Journal, 



NEW MODE OF OBTAINING RAPIDLY THE CONSTITU- 
TIONAL EFFECTS OF MERCURY. 



M. Petithan {Archives Midicales Beiges) has an article enti* 
tied, ''lodure Intus, Mercure Extra," in which he gives the 
benefits resulting from doses of iodide of potassium given by 
the mouth and followed in a few minutes with hyoodermic 
injections of the salts of mercury — as producing in jl short but 
variable time, a quite abundant salivation, a meto'lic or acid 
taste, sometimes nausea, and a lowering of the puic.3 and tem- 

Serature followed by a reaction. He was led to thin mie of the 
rugs by noting a curious case of mercurial intoxication result- 
ing from the internal use of an iodide simultaneously with the 
external use of a mercurial ointment 

He uses for his hypodermic injections a solution of cono- 



MBAT8 AND MILK — SECOND HEART SOUND. 41 

sive sublimate and also the peptonate. The results have been 
the same in both cases, but a little deferred in the case of the 
peptondte, in which it was also more painful. In six cases of 
syphilis the relief seemed to be hastened — the infinitely small 
quantity used, and the rapidity of the reaction, were both 
marked features in this new mode of application. 



DIGESTION OF MEATS AND MILK. 



Jessen has carried out a series of experiments to determine 
the time necessary for the digestion of equal quantities of 
-different meats and of milk. Three different methods were 
•employed in the investigation: (1) Artificial digestion; (2) 
introduction of the meats into the stomach of a living dog; (3) 
upon a healthy man, allowing him to swallow the foods used, 
and ascertaining the time of digestion by means of the stomach 
pump. 

The results obtained by the different methods were, on the 
whole, uniform, as far as the relative time necessary for diges- 
tion in each case was concerned, and may be stated as follows : 
Baw beef and mutton were digested most quickly ; for half- 
boiled beef and raw veal, a longer time is necessary ; thoroughly 
boiled and half wasted beef, raw pork and sour cow's milk fol- 
lowed next : fresh cow's milk, skimmed milk and goat's milk 
were still less easily digested; while the longest time was 
required for thoroughly wasted meats and boiled milk. — Science. 



THE PRODUCTION OF THE SECOND HEART SOUND. 



In the twenty-third volume of Pfttiger^s Archiv^ Professor S. 
Talma describes experiments which show that the sound pro- 
duced by the sudden tension of a membrane, loosely stretched 
accross tiie lower end of a vertical tube filled with water, varies 
in pitch inversely as the height of the fluid column. Hence he 
infers that the sound comes from the fluid, and not from the 
membrane. Further, that as the membrane is subjected to 
unequal pressure on its opposite sides, is in fact distended by 
the weignt of the water, it is not able to produce sonorous 
vibrations. He then concludes that the second sound of the 
heart, which is produced by the impact of a fluid column, the 
^arterial blood, a^inst membraneous septa, the semi-lunar 
valves, originates in the vibration of the blood, and not of the 
valves. 

On repeating these experiments by a modified method, G. E. 
Webster concludes that the second sound of the heart is the 
<3ombined result of the vibrations both of the fluid blood 
column and of the membraneous semi-lunar valves. — Joumcd of 
fhytiobgy. 



42 OVARIOTOMY — REGULATORY ALBUMINURIA. 

THE EARLY PERFORMANCE OF OVARIOTOMY. 



Mr. Knowsley Thornton, of London, read a paper on thi» 
subject. He first considered whether it was ever right to inter- 
fere with an ovarian tumor by tapping or aspiration. Spencer 
Wells, Keith, and Thomas, were in favor of tapping; and many 
other leading ovariotomists encouraged it. He gave quotations 
from Gross, Emmet, and Lawson Tait against the practice; and 
referred to the doubtful advantages claimed for this proceeding 
compared with its dangers and its immediate and remote mor- 
tality. He said that exploratory incision was far safer and 
better in doubtful cases. Tapping should be condemned except 
in some very rare cases. He would always remove an ovarian 
tumor as soon as it was large enough to be abdominal and 
slightly stretch the parietes. There were objections to operating 
eanier except in special cases. The danger lay in delay. Path- 
ological changes in the cysts might lead to the escape of their 
contents, and to the formation of adhesions; or the pedicle 
might become twisted. He adduced illustrations of the dancers 
of delay drawn from over four hundred ovariotomies he had 
performed, including forty cases in which ovarian fluid was free 
m the peritoneum, and thirty-four cases of twisted pedicle. 
He then summed up by considering the following questions: 
(1) Is tapping ovarian or parovarian cysts, or cysts of the broad 
ligament ever justifiable; and if so, what conditions justify 
it? (2) Can any fairly general, and defined rule be laid down 
as to the proper time at which to perform ovariotomy ; and if 
so, what conditions justify an earlier or later operation? 

He concluded by appealing to the profession to still further 
improve brilliant results of ovariotomy by condemning tapping 
and supporting early ovariotomy. — British Medical Jownuu. 



REGULATORY ALBUMIISTURIA. 



Bosenbach (Zeitschr, /. Klin, Med,, Edinburgh Clinical Jour^ 
na[) defines regulatory albuminuria as an albuminuria in which 
the quantity and quality of the urine are normal (except in 
containing albumen), and there are present no products of 
inflammation, such as tube-casts or blood corpuscles. In such 
cases the kidneys are for the time functionating more than they 
normally do, and the albuminuria arises from anomalies of the 
blood or of tissue-change, and not from anv disease of the kid- 
neys themselves. It is to be rememberea that in these casea 
the blood may be either absolutely or relatively richer in albu- 
men than is normally the case. In the first of these cases the 
blood holds absolutely more albumen in solution than normal,, 
and this may be due to a great absorption of albuminates from 
the blood to the transfusion of blood, or to peptonuria and the 
absorption of large pus collections. In the second case, the- 



OPENING OF PULMONARY CAVITIES. 43 

blood contains relatively more albumen than normal — rela- 
tively, that is, to its power of containing albumen — and this 
arises from increased loss of water through the skin or intestine^ 
from diminished supply of water to the system, or from dimin- 
ished functionating power in the white blood corpuscles. Id 
both these cases the excretory organs strive to reduce the albu- 
minous concentration of the blood to the normal level, and 
hence the regulatory albuminuria. 

Rosenbach holds that the onlv characteristics of nephritis 
in its strictest sense are white (and the so-called " fatty "> 
blood corpuscles. He holds that hyaline corpuscles are only 
an indication of the presence of albumen, since as is well known, 
they often occur when there can be no question of renal lesion. 
The red blood corpuscles are only indications that the process 
possesses considerable acuteness. 



OPERATIVE OPENING OF PULMONARY CAVITIES. 



Dr. E. Bull, (Christiana), in a paper on this subject, laid 
down the following propositions : 

(1) Abcesses of the lung, that can be diagnosed with certainty^ 
and are so situated that they can be opened through the chest 
wall, should be treated in the same way as pleural empyema. 

(2) The condition is the same with regard to limitea gan- 
grene of the lung. If several gangrenous foci exist, each one 
must be treated separately. 

(3) Echinococci, and 

(4) Foreign bodies in the lung are to be treated in a similar 
manner. 

(5) In bronchiectasis the formation of a pulmonary fistula 
is indicated only when the accumulation of stagnant matter in 
large cavities essentially contiibutes to the deterioration of the 
patient's condition. 

(6) In rare cases of tuberculosis, where a lar^e cavity is the 
predominating condition, the cavity may be laid open with a 
view of improving the condition of the patient. 

(7) The operative puncture of a pulmonary fistula is justi- 
fiable as a palliative measure. 

(8) In cases where diagnosis cannot be arrived at, explora- 
tory puncture is certainly of much value; positive as well as 
negative results may be aerived from it. 

(9) Adhesion of the layers of the pleura ought not to be 
insisted on as an absolutely necessary preliminary to the open- 
ing of pulmonary cavities. 

(10) Amyloid degeneration is not an absolute oontra-indi- 
cation to a palliative operation. 

(11) The use of the thermo-cautery is to be recommended 
both for the opening of cavities and for the destruction of dis* 
eased portions of lung-tissue. — British Medical Journal. 



1 



44 TREATMENT OP SPRAINS — ULCERS OF LEG. 

MASSAGE IN THE TREATMENT OF SPRAINS. 



In an exhaustive paper on '' Sprains and their Treatment" 
in Revue de Chir,, M. Marc S6e defines a sprain as consistixtg 
essentially in great distention with partial rupture of the 
ligaments and articular synovial membranes, causing a san- 
guineous exudation in the joint and its vicinity. To these 
lesions may be added in severe cases, muscular rupture, lact- 
ation of tendons, ligaments, and osseous apophyses rupture of 
fibrous sheaths, fracture of articular extremities, laceration of 
the skin, and contusion of subcutaneous tissue. He gives many 
suggestions as to treatment, and, among other things, lays down 
the following propositions regarding massage: 

It may l^ of great service in recent cases of slight sprain by 
relieving the pain and swelling. 

Grenerally several sittings will be necessary to produce any 
permament good results, but it is impossible to determine the 
number in advance. In the intervals the pain and swelling 
Tetum.to a variable degree. 

Massage generally succeeds best in the first hours after the 
accident Success is more rare after the sprain has existed 
«ome days and when ihere is a certain degree of inflammation. 
It demands much patience and time from both surgeon and 
patient For this reason it is often left to empirics, who abuse 
it It does not always succeed, even in simple cases; it is dan- 
gerous in severe cases and those complicated with fracture. 
After the disappearance of the primitive symptoms of a sprain 
the disease is not cured. The cicatrization of ruptured parts 
cannot take place till after a considerable time, and requires 
immobilization of the joint It is, therefore, imprudent to 
allow the patient to walk immediately after the treatment by 
massage. 

DRESSING FOR ULCERS OF THE LEG. 



Lister's boric acid dressing applied with a crinoline bandage 
has been found a very convenient dressing for ulcers of the leg. 
Its advantages are: (1) Firm and lasting support, even ena- 
bling the patients to walk : (2) Asepsis and non-disturbance of 
the part; (3) Economy of time to both surgeon and patient; 
(4) Economy of material. Dr. Curtis describes (iNfew? York 
Medical JoumcU) the mode of application at the out-patient 
department of the Chamber Street Hospital, as follows: 

The leg and foot are thoroughly washed with a one to forty 
carbolic acid (or one to one thousand corrosive sublimate) 
solution, and the ulcer itself is washed with a saturated solution 
of boric acid. Over the ulcer is put a piece of thin gutta-percha 
tissue (as a substitute for the Lister macintosh), large enough 
to extend about one-fourth of an inch beyond its edges on all 



E8CHAROTIOB — MISCELLANEOUS ITEMS. 4$ 

ndes, which has been soaking for some minutes in the boric 
acid solution. The leg is wiped dry, sufficiently borated or 
salicylated cotton to take up the discharge, is laid oyer the 
ulcer, and the rest of the leg, from the ankle to the knee, is 
wrapped in a half-inch layer of cotton-batting. An ordinary 
bandage is applied to the foot. 

The crinoline bandage (three inches wide, ten to twelye 
yards long) has meanwhile been soaking for five minutes in 
water, an^it is now squeezed quite dry anH snugly applied over 
the cotton from the ankle to the knee, makinff a thickness of 
three or four layers. Care must be taken to haye the cotton 
project beyond both its upper and lower edi^es, as they must 
excoriate the skin when dry and stiff. In half an hour the 
crinoline will be dry : but, if time is important, an ordinary 
bandage may be applied outside of the crinoline, and the 
patient dismissed at once. 



PAINLESS ESCHAR0TIC8. 



A painless caustic for the removal of warts and tumors may 
be made as follows: 

Arseoious acid 1 part. 

Salphate of morphine.... 1 part. 

Galomel 8 parts. 

Powdered gum arable 48 parts. 

This is to be sprinkled over the cuticle daily, the surface of 
which had been previously denuded by knife or blister. 

Canquon's paste for the same purpose is composed of ten 
parts of chloride of zinc, two parts or alcohol (sixty degrees), 
and fifteen parts of wheat flour. The zinc in fine is added to 
the alcohol^ then incorporated with the flour in a mortar,, 
strongly pressing with the pestile. As soon as homogeneous it 
is spread with a roller into sheets an eighth of an inch thick^ 
and after a few hours put into a well-corked bottle. 

Satour's nitro-chloride of zinc paste is also an excellent pre«- 
paration, and is made by dissolying fifty parts of the chloride 
and one hundred i)arts of the nitrate of zinc in eighty parts of 
water. The solution is made by the aid of heat. When it 
cools, seyenty-four parts of wheat flour are incorporated with 
one hundred parts of the solution, as with Canquon's paste. — 
SdeiUifie American, 

MISCELLANEOUS ITEMS. 



Chloral hydrate should be administered alone or in some 
simple solyent. — New England Medical Montldy, 

The best remedy for chilblains is a mixture of one part, by 
measure, of tincture iodine ^and three parts glycerine. — New 
England Medical Monthly. 



46 MISCELLANEOUS ITEKS. 

CoRT F. AsKREN, of Corydon, Indiana, states: "I am using 
Mellier's standard buggy-case, and consider it the neatest most 
durable and most convenient that I have ever seen." 



A Method op Cleaning Catheters. — ^A correspondent for 
the Lancet says: ''Take a cork of more conical form than that 
^commonly used, with a hole made through it longitudinally; 
pass the catheter through the hole, and fix the cork into the 
tap of an ordinary water-pipe (hot- water preferable), and turn 
on the water. By so doing the catheter is properly cleansed.'' 

C. W. Prindle, M. D., Grand Rapids, Michigan, states: 
^' Have used tonffaline extensively in all forms of neuralgia and 
rheumatism, finding it a safe, easy and efficient remedy. For 
all the cases of neuralgic or rheumatic pains accompanying 
the colds that predominate in this damp and malarial region, 
it seems to be a specific. I take pleasure in recommending it 
to the profession.'' 

Solidified Creosote. — In its application to carious teeth, 
>creosote is often inconvenient in consequence of its fluidity pro- 
ducing ill-efiects upon the mucous membrane of the mouth. 
This may be obviated by giving to it a gelatinous soliditjr by 
adding ten parts collodion to fimen of creosote. This, besides 
being more manageable than liquid creosote, also closes up the 
orifice in the tooth, preventing the access of air to the dental 
nerve. 



A noted physician says, r^arding the infants, " never give 
the child anything except fresn milk and a properlv prepared 
artificial food until it has the majority of its teeth.^ Dr. J. 
Lewis Smith, Professor of Diseases of Children, Bellevue Hos- 
pital Medical College, New York, says: ^'The one food in a 
drug store which on account of its excellence, merits most the 
<confidence of the profession, is Horlick's Food for Infants." 
Book on treatment of children sent free. Horlick's Food Com- 
pany, Racine, Wisconsin. 

Professor DaCosta states that tonsilitis may often be 
aborted by an emetic if given early when the pain and swell- 
ing are just beginning to appear. After the attack has. been 
fully established the best treatment will be to keep the parts 
clean by the frequent use of mild boracic acid or permangan- 
ate of potash gargles, and to prescribe small doses of pilocar- 
pine or jaborandi sufficient to keep up slight salivation. If the 
swelling of the tonsils, and difficulty of swallowing become 
very great, free scarification will generally give immediate relief. 
— New England Medical Monthly. 



MISCELLANEOUS ITEMS. 47 

Professor C. H. Hughes, Lecturer of Psychiatry and Neu- 
rology, Post-Graduate Faculty, Saint Louis Medical College, 
Editor Alienist and Neurologist^ etc., says in the December num- 
ber, 1882, of that journal: "Bromidia is a reliable compound 
of well-known and favorite medicines in the management of 
insomnia, and as such we commend it to those of our subscrib- 
ers, hospital physicians and others, when occasion requires the 
«mp>lojrment of this combination of the potassic bromide, can- 
naois indica and chloral hydrate. We have always found the 
compound unihrm in composition, the mixture well made and 
therapeutic effect what ought to be expected from its iixgre- 
dients." 



Nitrate 01 Silver in Spinal Irritation. — Dr. Betz strongly 
recommends this as a means of relieving the attendant pain, 
whatever may be its primary cause. A solution of one part of 
nitrate of silver to one hundred parts of alcohol is thorougly 
applied twice a day not only to tne painful parts, but also for 
some distance beyond there, and, when necessary, along the 
whole spinal column. The liquid penetrates quickly, and soon 
dries up, producing an agreeably cooling sensation, and very 
seldom gives rise to any irritation of the skin. This painting of 
the parts will have to be continued for weeks or even monuis, 
especially if there is any disease of the spine itself present — 
MeTnorcUnlien, 



Cinnamon Bark for Toothache. — In the North Carolina 
Medical Journal^ April, 1884, Dr. J. B. Irwin writes that one of 
the best and most pleasant things that can be used to relieve 
this painful state of the dental nerves, is chewing cinnamon 
bark. It destrovs the sensibilities of tne nerves and suspends 
pain immediately, if the bark is of good quality. After repeated 
trials^ and in different cases, he is convinced that it is gener^y 
as efficacious as any of the other remedies suggested for odon- 
talgia, and not attended with the unpleasant consequences of 
creosote, carbolic acid, etc., which relieve the pain, but leave 
the mouth as sore and painful as the tooth was previously, 
though these results are usually due to carelessness in using. 



'' Mineral-Earth " is a surgical dressing designed to be used 
by physicians. It may be applied with advantage in the fol- 
lowing conditions: to wounds and ulcers, to ulcerating forms 
of malignant diseases, to catarrhal inflammations, to various 
cutaneous troubles, to erysipelas, gangrene and dropsical swell- 
ings, to various tumors and other morbid growths, to burns, 
and to bites from poisonous insects and reptiles. In order to 
insure the genuineness of this preparation, it is put up in sealed 
glass jars (4x5x2i inches), each jar being numbered and bear- 



48 MIBCBLLANEOUB ITEMS. 

ing the trade-mark of the company — "Mineral -Earth" — ^and is 
sold b^ the principal druggists throughout the United States at 
the uniform price of fifty cents. 

Nasal Polypi.— Dr. WiUiam Ralph Bell describes a new, 
painless and simple method of removing nasal polypi. Hia 
patient is instructed to blow strongly through th*e affected 
nostril while he closes the other with his finger. Tliis brings 
the polypus down so it can be seen. He then injects into the 
tumor with a hypodermic syringe fifteen or twenty minims of a 
solution of tannic acid in water, twenty grains to the fluid 
drachm. In a few days the tumor shrivels, dries up, and come& 
away without pain or trouble, the patient usuidly removing it 
with the fingers or by blowing the nose. — Canada Medical Record. 

IIoMCEOPATHic FARMING. — It is told of the son of an Ohio 
farmer, who had been studying with the view of becoming a 
homoeopathic physician, that he was seen tying a number of 
sacks containing about a teaspoonful of some thing to the fence 
stakes on the windwardfside of the wheat field. *' W hat are you 
doing, Tom ? " said a neighbor who happened alon^. *^ I am 
homoopathically fertillizing this wheat field. These little sacks 
each contain one drachm of fertilizer, the vital element of 
which will be broadly disseminated over the fields by the sum- 
mer winds, which is much better than scattering the stinking 
stuff" with a shovel." ** Well, you may be right, out if I ain't 
much mistaken you will eat homoeopathic biscuits this winter," 
observed the foggy farmer. — Exchange. 

A Test for the Pority op Iodoform. — Dr. Bouma, of 
Leaden, is of the opinion that the symptoms of iodoform pois- 
oning are due to the presence of impurities in the drug used, 
and m the OentraiblaM of Ohirurgie {Okutgow Medical Journal^ 
brings forward striking facts from the practice of several sur- 
geons in proof of this. He holds that no iodoform should be 
used which has not been tested for impurities, and states that 
he has not yet seen unfavorable symptoms arise in a case 
where this rule has been adhered to. The most reliable test is 
a modification by H. Azema, apothecary to the Leyden Hos- 
pital, of one given by most authorities, and consists in shaking 
up the iodoform with distilled water, filtering, adding to the 
filtrate an alcoholic solution of nitrate of silver, and allowing 
this to stand for twenty-four hours. At the end of this time a 
slight grey deposit will be found in the bottom of the test tube; 
but anything approaching to a black precipitate (reduced 
silver) indicates that the iodoform is not pure enough to be 
used. Dr. Bouma believes, however, that iodoform which has 
been kept for some time exposed to light and air may cause evil 
effects, even though this test fails to detect impurities. 






THE 



PHYSICIAN m SURGEOl^ 

A MONTHLY MAGAZINE, 
DEVOTED TO MEDICAL AND SURGICAL SCIENCE. 



Volume VII. FEBRUARY, 1885. Number II. 



ORIGINAL ARTICLES. 



A FAMILY RECORD SHOWING THE HEREDITY OF DISEASE. 



BY HARRIET U HARRINGTON, M. D., BOSTON, MAtSA.CHU8ETTS. 



I was sent for in great haste December 15, 1884. at 2 p. m. to 
see a woman forty-six years of age, who had been lying uncon- 
scioas for about one-half hour. Her mother told me that at 
about 1:30 p. m. she had called to her, saying she had an ill 
turn. When she reached her she was sitting up on the floor, 
but did not speak. Her mother said somethinc: to her about 
sending for a doctor; then the patient said, **No! don't," and 
became unconscious at once. When I reached the house I 
found her in an entirely unconscious condition, breathing 
heavily; respiration, 20 per minute; face flushed; skin a yel- 
lowish white color; seemed quite rigid most of the time; would 
have an occasional chill, when she would shake all over, and 
once or twice tried to pull the covers over her. Pulse, 60, full, 
strong and regular. A decided murmur could be heard over 
the mitral valve, directly after the second heart beat. Right 
pupil was contracted down quite small; left pupil was slightly 
dilated — ^both eyes bulging— right lower eyelid drooping. Her 
mother said at first her face had twitched a good deal, espe- 
ciallv around the mouth: teeth were clenched together; jaws 
rigid; a little froth on lips at times; vomited some, and it 
seemed almost impossible to get anything out of her mouth. 

My diagnosis was "cerebral apoplexy," and although I felt 
that the case was a hopeless one, something had to be done. 



50 THE HEREDITY OP Dl8£:ASfi. 

At first I applied cold to head, chest and over heart, and heat to 
feet. This seemed to revive her somewhat, but only momen- 
tarily. I then put mustard over hear!, over entire length of 
spine, to feet, hack of legs, and to wrists. At first I coul<l not 
get her to hwallow anything. I guve as soon as I could, a little 
brandy and aromatic spirits of ammonia. The heart beat 
changed from 60 to bO per minute, and the breathing became 
quite natural for a time. At 3:30 her entire head and face 
became bright scarlet, and^Aftjff^aLfromqnt pale again. Another 
haemorrhage into the Jbj^rOi xriwOtwK pupils but neither 
would respond — eith^fo l|g.^^^gf_toufct^^he right one was 
drawn out to outer/ejtrner of ^c^ Ju^pcfflMonal groan came 
with the heavy bipijthiligt r^Af^-^p^MC shiej entirely 

relaxed, as if quiet^ sil^^P'Ofo^-^^Xii.'^ lasted jantil 5 p. m., whf n 
all the bad syinptoraB pftuj-neciTj'ha'ftfcre^^ became very 
much labored, a pulK^^>titI^| ^^ breath; the face 

looked dark colored, riim^iwnTlrni h(Tliiini1i became slightly 
discolored; she lost all control ovit the bladder. Consultation 
was called, but she passed away quietly at 5:3U p. m. — ^just four 
hours from the time she was taken. 

Family History. — Two sisters had died — both in a nimilar 
manner — within one year of each other, a few years ago; one 
aged thirty-two years, the oilier thirty yt*ars; also an uncle, 
and the day before this patient died, another uncle, bn^ther to 
the one just referrfd to, became suddenly unconscious and 
paralyzed, and lived but a few days. Patient's mother, father, 
and one sister— the only remaining one — have all been troub- 
led with their heads. The father has a great deal ot head- 
ache; thinks it due to a severe blow he had on his head some 
years ago; is also troubled with loss of nieniory. Tim mother 
once had an ill turn, in which she fell from her chair; was 
unconscious for some time, and sick in bed for a week or more 
alterwards. The sister is troubled a great deal with her head, 
has "tinnitus aurium," and is quite sick at times from head 
trouble. The jmtient who died had complained of her heart 
for a good many years, and for several months her head had 
been troubling her from loss of memory; could not remember 
one line at a time while reading; head was much confused at 
times; had had much headache, and was very despondent at 
times. 

On December 22 I was sent for to see the mother of the 
patient who died on the 16th. Found my patient, a woman 
about seventy years of age, looking very pale, and feeling quite 
weak from loss of blood. The evening previous while sitting 
quietly in her chair, her nose began to bleed. She thought 
nothing of it at first, butaftera while, finding it did not stop,she 
tried, one after another, several domestic lemedies for checking 
hemorrhage, but not until she had bleed profusely for over an 
^hour did she succeed in checking it. She felt very weak, but 



■ 
1 



tttE maxDTtt or BisEAsft* 51 

went to bed and slept well all night, but the moment she put 
her feet to the floor m the morning, the hsBmorrhage started up 
again, and was a repetition of tne previous evening, lasting 
about the same length of time. I found on examining the 
heart, a decided blowing sound between the two beats, or 
taking the place of the second beat — it was almost impossible 
to tell positively which. Pulse 100, full; face pale, but cheeks 
flushed. 

I ordered perfect rest and quiet; cold to head; heat to ibet. 
Spirits of turpentine to be inhaled, and potassium bromide five 
grains every nour. 

Evening of same day found her very comfortable, but just 
as I was leaving another hemorrhage commenced. This time 
all domestic remedies failed. I tried the hot nasal douche; 
mustard to back of neck; compressing the nostril; and several 
other things, but these alt failed. At first the blood came only 
firom the left nostril. I plugged this nostril anteriorly, and the 
blood came through the other nostril, and when prevented 
from coming through either nostril, it came through her mouth. 
All the time she kept spitting mouthfuls of blood. I used 
tannin, but this failed. I tried ice to bridge of nose, to head. 
I put it in the nostril, and let the patient chew it. At first this 
did not avail much. I then got everything ready to plug the 
posterior nares, when I found the haemorrhage was checking a 
little, and as both nostrils were filled with clotted blood, I felt 
it was best not to remove it, so I worked on with the ice, and at 
8:15, about one hour after the hsdmorrhage commenced, I suc- 
ceeded in controling it, but still it would drop occasionally for 
an hour longer. I ordered cold to the head, and heat to feet, to 
be continued; also gave extract ergot, fluid, ten drops; also 
potassium bromide, ten grains, every three hours, and left her 
quite comfortable at about 9 p. m. 

^ I kept her quiet in bed for about a week, and all during 
this time she spit a great deal of blood. The nostrils cleared 
so she could oreathe freely. She still remained very weak, 
also very pale. I prescribed tincture ferri chloride, ten drops, 
to be taken three times daily, and dismissed her. 

I believe this nasal hsemorrhage prevented her having some- 
thing more serious, as her head had been troubling her for some 
time. It had felt full, and she had dizzy spells; seemed con- 
fused at times, and after the haemorrhage all these symptoms 
disappeared. 

The long accepted law of heredity is now frequently attacked, 
and it is argued, notably in criminal courts, that the transmis- 
sion of disease down through generations, and the existence of 
a family tendency to a certain form of disease is not nearly so 
frequent as formerly supposed. As long as such remarkable 
examples are observed the physician must continue to regard 
heredity an important factor in the cause of disease. 



52 UNSAKltARY CONDITIOKS OF LUMBERMEN. 

UNSANITARY CONDITIONS OF LUMBERMEN IN NORTHERN 

MICHIGAN. 



BY GEO. H. CLEVELAND. M. D., Moorbstown, Missaukeb County, Michigan. 



I speak of the unsanitary surroundings of this class of peo- 
ple in Northern Michigan particularly, because I am situated 
where I have every facility for observing these conditions; but 
believe that all through the north where lumbering operations 
are extensively carried on, the same conditions would be noted. 

We often see descriptions and reports of the sanitary condi- 
tions of prisons, insane asylums, tenement houses, and other 
{>laces where numbers of individuals are congregated for any 
ength of time, but I do not recollect meeting anything in my 
readings bearing upon the life of a lumberman from a sanitary 
point of view. 

I believe I am safe in stating that but very few people, and 
fewer sanitarians, have ever visited a lumber camp, or have a 
correct idea of the condition of things there existing. 

I am not aware of a class of people — not excepting the ten- 
ement population — who sleep surrounded by such a vile atmos- 
phere ana under such unhealthy conditions. 

But let me describe in a brief manner the actual state 
of the living quarters of the woodsman; and by drawing 
an outline of one such "camp" you will have an adequate 
idea of all others. The building is low, constructed of logs 
and possesses one small window, whose sole duty is the trans- 
mission of light, the idea of ventilation never being thought of 
A large wood stove occupies the center of the room, and along 
the sides are arranged "bunks," two and three tiers high. Two 
men are assigned to each "bunk," and from twenty to eighty 
men constitute a "camp." Arising early, eating crude, coarse, 
but healthy food, dressing warmly, and working out of doors 
entirely in the pure air of the pine region, the lumberman's con- 
dition during the daytime is anything but unhealthy. But it is 
at night, when his system requires rest and refreshing sleep, that 
the unsanitary demon lurks around the slumbering form of 
the strong woodsman and seeks to rob him of his only wealth. 

After the evening meal, the twenty, forty, or eighty men of 
the camp all congregate in this one room, and as each man is 
invariably a tobacco fmoker, the atmosphere of said room will 
soon be transformed into a heavy blue tobacco fog. No venti- 
lation remember. This will last about two hours, when the 
men will roll into their respective "bunks," six men occupying 
a cubic air-space of between two and three hundred feet. The 
air may be considered almost permanent, the law of diffusion 
being apparently totally ignored. Not only permanent is the 
air, but it is loaded with fumes of the poorest tobacco, and vile 
emanations from bodies that, I may say, are seldom or never 



MEDICAL STUDY IK LONDON. 53 

bathed. You who are accustomed to spacious sleeping apart- 
ments, perfect ventilation, soft and well aired bed-clothing, a 
soft pillow, and clean bodies, imagine the condition of things I 
have endeavored to portray, and tell me, could you have sweet 
dreams, and in the morning fully realize the benefits of ^' na- 
ture's sweet restorer?" Why, I dare say, there are many who 
could not be induced to pass one night under these conditions 
for fear of costing them their lives; and yet can you point out 
a more robust class of individuals? 

The woodsman is often spoken of as the ** ideal of a strong 
constitution," as the " type of health." Is this then a contradic- 
tion of well established sanitary laws? Let us follow this thread 
a little further and note the ultimate result. Look along the 
line effaces you see in this camp of sixty men and select for 
me ten, yes, five even, who have passed tne limit of one score 
years and ten. Most of these you see are young, strong, vigor- 
ous and healthy, but they do not last long as woodsmen. They 
soon begin to complain of dyspepsia, headache, constipation, 
etc., and on some of the poor fellows you will notice a distant 
expression, a tinted cheek, and will hear that hollow cough 
which too plainly indicates the eflFect of bad hygiene. Tqe 
establishment of the many lumberman's hospitals has not been 
for the purpose of treating surgical cases alone, but they receive 
liberal patronage from those whose complaints are distinctly 
traceable to the conditions I have mentioned. The food of the 
average woodsman is plainly cooked and wholesome, but the 
water is invariably totally unfit for use. In many instances 
there is no well, properly speaking. One or two barrels placed 
in the ground endwise and allowed to fill with surface water, 
answers all purposes. Even if fortune favors them with spring 
water, it is allowed to stand in this room occupied by the men 
where it becomes contaminated very much from atmospheric 
impurities, etc. 

But little complaint, however, is heard, and all appears to 
be happiness under this cloud of danger. 



GENERAL CORRESPONDENCE. 



MEDICAL STUDY IN LONDON. 



To THE Editor op The Physician and Surgeon : Thinking 
some ideas concerning medical study in London might interest 
the readers of your journal, I send you the impressions gathered 
from a number of visits to the metropolitan hospitals. The 
courtesy with which American physicians are treated, and the 
facilities for observation given them, make a very favorable 
impression at the outset The arrangements for undergrade 



54 MEDICAL STUDY IN LONDON. 

uates are admirable, and are being followed by some of our 
own institutions, notably, Johns Hopkins University among 
others. The liospital is the student's field of studj^, and each 
leading institution has a medical school in connection with it. 
The advanced students have duties in the wards and are 
there daily, and thus, in a measure get an hospital training 
along witii their didactic lectures. 

Surgery at Saint Thomas' has been running low of late. Sir 
William lilacCormac was on duty, and the afternoon was spent 
in operations on cicatrical contractions following bums, and in 
a lecture on the subject to the students who formed most of the 
audience. Little visiting is done between the students of the 
various hospitals, ami an esprit du corps exists which finds its 
counterpart with us only among students of literary colleges. 
Sir William has the reputation of being quite "antiseptic,'' but 
his practice failed to impress one accustomed to the thorough- 
ness which Dr. Lange inaugurated in Bellevue Hospital. The 
details, without which antisepsis is useless, seemed neglected — 
instruments were handled by the unwashed hands of orderlies, 
etc. The operations, however, were finely performed. 

Guy's hospital, from its reputation, age and size, takes rank 
as one of the leading hospitals, though far inferior to Saint 
Thomas' in point of location, the latter being beautifully situated 
on the Thames opposite parliament buidings. I give the pro- 
gramme of one operation-day at Guy's, from which one may 
get an idea of the amount of work done here yearly. 

Excision hip. 

Breaking up knee adhesions. 

Exploration of bladder by lateral incision. 

Radical cure of hernia. 

Epithelioma lip. 

Radical operation for hydrocele. 

Epithelioma of lip and cheek. 
These were performed by Messrs. Howse, Davies-CoUey, Gold- 
ing-Bird and Lucas. Mr. Bryant was present but did not 
operate. The spray is still in use here and great attention is 
paid to antisepsis. The medical visits to the hospital are made 
by the phvsicians at hours which do not conflict with the sur- 
geons, and the students follow the doctor from bed to bed in 
the wards. 

Saint Bartholomew's impresses one ver}^ favorably, it being 
large, light and very neatly kept. Its library is one of the 
finest in the city and embraces works on all departments of 
science. But little attention is paid in London to graduates 
seeking special instruction and very few private courses are 
given. Moreover, the distance separating the hospitals causes 
one to lose valuable time in getting about, provided indeed that 
special courses coidd be found. An exception perhaps should 
b^ made in the case of ophthalmic study. By visiting Moor- 



IfUBIATE OF OOGAINK. 56 

field's and the Westminster Royal Ophthalmic one can get val- 
uable instruction from either Mr. Lawson, Mr. Twttedy or Juler, 
and see an immense number of cases at the clinics which these 
gentlemen attend. The ear is not studied with the eye but 
with the throat, and otology must be studied at the throat hos- 
pitals. 

In orthopaedics I think London far behind our country. 
They repudiate, at the Roynl Orthopaedic Hospital, entirely, Dr. 
Sayre's principle of extension and fixation in hip and spinal 
disease and use no plaster of Paris. When asked what they 
substituted for the hip extension splint, they said they required 
hip disease cases to remain in bed until they recovered or died, 
usujjlly the latter. 

The syptem in vogue here in the study of insanity and nerv- 
ous diseases is ex<;ellent, and is the only branch except the eye 
course, which it would seem wine for a specialist to come here 
to study. The Beti)iehem Insane Hospital is the most conven- 
ient institution both in location and material. A class of six 
or eight doctors accompanies the physician daily in his rounds 
and bedside lectures are given. A large number of patients 
are seen daily and individual cases can be followed up and 
their variatinns studied very satisfactorily in the period of time 
given ench course. Quite a number ot American physicians 
are studying thin brunch. Students pursuing advanced courses 
in otlitr subjects, however, can scnrcely l)e found. They go, 
and widely, to Gerninny, where preeminent attention is given to 
pofc^tgraduated aud special courses— where often the hospitals 
for every branch are under olc roof and more cases can be 
seen in one month than in six elsewhere. 

Yours truly, 
Arthur W. Hurd, M. D., of Detroit, Michigan. 

LoKDON. Januaiy, 1885. __^ 

MURIATE OF COCAINE: A CORRECTION. 



To THE Editor op The Physician and Surgeon: Having 
read your very interesting e itorial entitled ** Cocaine: History 
and Clinical Uses," in the January number of The Physician 
AND Surgeon, I desire to make a few remarks upon the subject 
1 quote the following from the editorial referred to: "Dr. C. J. 
Lundy, of Detroit, ol'served slight hyperamia in all cases. The 
parts, when incised, bled more freely than usual." In my ear- 
lier experience with cocaine, I was led to believe that in most 
capes it caused hypersemia, but from more extended observation, 
I must qualify the opinions previously expressed upon this 
point. It is true, in many cases, a slight hypercemia may be 
obperved soon after the uee of cocaine; but this hypersemia is 
not due to the cocaine per ae. If the salt — muriate, oleate, etc. — 
is not perfectly neutral, or if it contain any impurity, irritation 



56 MUBIATE OF COCAINE. 

of the coDJunctiva and consequent hypersemia will be likely to 
follow its use. Then again, many people have sensitive con- 
junctivse, and even a drop of water dropped into the eye would 
cause temporary hypersemia. As regards the action of cocaine 
upon the blood-vessels, I think we now understand it better; 
and repeated observation would tend to show that, the case of 
the medical student, reported by me in The Physician and 
Surgeon for November, illustrates the action of cocaine upon 
the blood-vessels. When small quantities of a pure, perfectly 
neutral salt, are employed, it undoubtedly causes contraction of 
the blood-vessels and proauces an ansemia of the parts. Any 
one can demonstrate this to his own satisfaction. Whether this 
contraction of the vessels is ultimately followed by any marked 
dilatation I am not now prepared to say. 

In regard to free bleeding when the parts are incised, I have 
the following to offer in explanation: In small quantities the 
cocaine stimulates the vaso-motor nerves, and causes contrac- 
tion of the blood-vessels; while in large quantities the cocaine 
produces a partial paralysis of the same nerves and dilatation 
of the vessels. In many of my operations, I used cocaine very 
freelv in order to anaesthetize the tissues to a considerable 
depth, and where the use of the drug was carried beyond a cer- 
tain point. I was of the opinion it produced a partial vaso- 
motor paralysis and free haemorrhage followed, if this is not 
the explanation, I cannot account for the very free bleeding 
which has occurred in several of my operations after the very 
free use of cocaine. A few days since I removed a "sero-cys- 
tic" tumor of the orbit for a Miss Davis, of Detroit, and used 
cocaine as the amesthetic, both by droppingit into the eye and by 
injecting it into the surrounding tissues. The solution employed 
was a five per cent, of Merck's muriate. In the operation I was 
assisted by Dr. Benjamin Brodie and by my student Mr. 
Dumas. Both of these gentlemen and myself noticed the 
marked diminution in the size of the vessels following the first 
applications of the cocaine. As I desired to remove the cyst 
without rupturing its delicate transparent walls (and I suc- 
ceeded), the operation consumed considerable time and a large 
amount of cocaine was used. Before the completion of the 
operation the haemorrhage became so profuse as to seriouslv 
interfere with the progress of the operation. Indeed the bleed- 
ing was much greater than I had observed when performing 
several similar operations under chloroform. Two days ago I 
removed a "chondroma" which involved the lower lid and 
temporal side of the orbit. In the operation I received valuable 
assistance from my friend Dr. Hamilton E. Smith, and he 
agrees with me that the bleeding was very profuse after the use 
of cocaine, which was the anfieqthetic employed. In this case a 
smaller quantity of the cocaine was employed than in the case 
of Miss Pavis, and the hemorrhage was not so profuse. In 



HEALTH IN MICHIGAN. 



57 



stating that I have obBerved free haemorrhage in many of m^ 
operations where I have employed cocaine — and I have used it 
in about one hundred operations — I only give my individual 
experience. This may be at Variance with the experience of 
others, and possibly my conclusions have not been correctly 
drawn. Time will determine this point, and I am willing to 
watch and wait. C. J. Lundy, M. D. 

DsTBoiT, February 4, 1885. 



HEALTH IN MICHIGAN DURING DE(;EMBER, 1884. 

Reports to the State Board of Health, Lansing, by observers 
in different parts of the State, show the diseases which caused 
most sickness in Michigan during the month of December 
(five weeks ending January 3), 1885, as follows: 



Number of Weekly Reports received, 234. 



I Per cent, of re- 
Diseases arranged i n order of greatest jports stating 
prevalence. | presence of dis- 

!ease. 



For preceding 
month. 



Rheumatism 

Nearal$[ia 

Bronchitis 

Tonsilitis 

Consamption, of langs 

Intermittent fever 

Inflaenza. 

Remittent fever 

Liarrhcea 

Pneumonia 

Erysipelas 

Inflammation of kidneys 

Typho-malarial fever 

Dipbtheria 

Inflammation of the boweis. 

Whooping-cough.. 

Typhoid fever (enteric) 

Scarlet fever 

Membranous croup 

Cerebro-spinal meningitis.... 

Cholera morbus 

Dyaent^TV 

Puerperal fever 

Inflammation of brain 

Measles. 

Cholera infantum 



77 
72 
70 
56 
54 
53 
52 
40 

:^« 

34 
25 
23 
21 
]9 
17 
17 
Hi 
35 
10 

() 
(i 
5 
o 

4 
3 



Per cent, of re- 
ports stating 
presence of dis- 
ease. 

70 

72 

67 

58 

58 

60 

42 

44 

46 

29 

27 
•> 

35 
19 
19 
13 
22 
13 
10 

4 
12 
10 

6 

8 

() 

8 



For the month of December, 1884, compared with preceding 
month, the reports indicate that inflammation of kidney, influ- 
enza and rheumatism increased, and that typho-malarial fever, 
diarrhcea and intermittent fever decreased in prevalence. 



58 MICHiaAM STATE BOARD OF HXALTH. 

Compared with the average for the month of December in 
the six years, 1879-1884, inflammation of bowels, cerebro- 
spinal meningitis, influenza, neuralgia and erysipelas were 
more prevalent, and intermittent hwer, diphtheria, consump- 
tion of lungs, pneumonia and membranous croup were less 
prevalent, in December, 1884. 

For tLe month of December, 1884, compared with the aver- 
age of corresponding months for the six years, 1879-1884, ths 
temperature was considerably lower, the relative humidity 
more, and the absolute humidity, and the day and the night 
ozone were l-ess. 

Including reports by regular observers and others, diph- 
theria was reported in Michigan in the month of December, 
1884, at forty-nine places, namely — Ameden, Armada, Ann 
Arbor, Byron Center, Bruce, Boardman, Bloomingdale, Con- 
stanline, Cadillac, Detroit, Danby, DowaKiac, Eramett, East 
Saginaw, Franklin, Green Oak, Grand Rapids, Genoa, Hanover, 
Holly, Hudson, Hastings, Harrisville, Ingham township, Ish- 
peming, Kalamazoo, Lowell, Meredith, Muskegon, Marengo, 
Manistee, Northville, Owoaso, Orange, Orleans, Pinconning, 
Ponliac, Porter township, Port Huron, Quincv, Royal Oak, 
Richmond, Saint Johns, Texas, Vassar, Venice, Veruon, Water- 
vliet, Wyandotte; scarlet fever at thirty-six places — Armada, 
Albion, Brockway Center, Carson City, Detroit, Dowagiac, East 
Saginaw, Freesoil, Fawn River, Grand Rapids, Gnmd Haven, 
Garfield, Hanover, Howell. Ida, Ishpeniing.lihaca, Kalamazoo, 
Leavitt, Lansing, Leelanaw, Manistee, Muskegon, Negaunee, 
North Muskegon, Northport, Owosso, Pontiac, Quincv, Sears, 
South Haven, Texas, Tliornville, Westphalia, Whitehall, Wyan- 
dotte; measles at six places — Detroit, East Saginaw, Fawn 
River, Grand Rapids, Port Huron, Whitehall; small-pox at 
South Boardman. Henky B. Bakek, Secretary. 

Lapsing, Jaiiuary 9, 1885. 

MICHIGAN STATE BOARD OF HEALTH. 



RhPORTED FOR THE PHYSICIAN AND SUROEON. 



At the quarterly moetin^ of the State Board of Health of 
Michigan, held January 13, 1885, at its oflice in Lansing, the 
following named ineniliers were present: Dm. Avery, Lyster, 
Hazlewood, T\ 1( r and Biker. 

The secretary mentioned that durins: the quarter a success- 
ful sanitary convention had heen held in E.ist Saginaw, and 
that steps had been taken by citizens of Lansing to hold a san- 
itary convention in Lansing in March next (March 19 and 20, 
1885). The secretary had attended, as delegate of the Board, two 
meetings of the Conference of State Boards of Health, one in Saint 
Louis, Missouri, in October, and one in Washington, District of 
Columbia, in Pecember. In the former he was cbairmau of the 



1^ 



UlCElQJkX BTATX BOABD OF HBALTU. 59 

committee which prepared the report on practical means of 
preventing the introduction and spread of cholera in this coun- 
try, which was adopted by the Conference and also by the 
American Public Health Association. It has been widely pub- 
lished. In the Conference at Washington he read a report on 
the sanitary condition of Michigan and preparations made for 
meeting the threatened invasion by cholera, and was a mem- 
ber of the committee on best methods of action by the national 
government to prevent the introduction and spread of cholera. 

Bound volumes of the Annual Report for the year 1883 
had been received from the printers, and this and other doc- 
uments have been mailed to all health officers in the State, 
to clerks of cities and of villages, and to mayors of cities 
and presidents of villages. A large number of circulars in 
English and in foreign languages, on best means of restricting 
and preventing certain communicable diseases had been sent to 
health officers where contagious diseases were present. A large 
number of Annual Reports, reprints, and circulars have been 
sent to persons interested in sanitary affairs. Blanks for reports 
of diseases dangerous to public health, with circulars of instruc- 
tions, were sent to all health officers of cities, villages and town- 
ships in the State to the number of one thousand three hun- 
dred and ninety. Another set for reporting communicable 
diseases in 1884 was sent to the clerks of cities, villages and 
townships in Michigan. Two copies of a circular relative to 
disea-ses in Michigan during 1884, and stamped envelope for 
reply have been sent to about one hundred and eighty physi- 
cians in Michigan wh 3 are regular correspondents of the Board. 

The secretiiry also reported that since October 7, there had 
been four outbreaks of cheese-poisoning in Michigan, at Jack- 
son, Homer, Flushing, and Landing. During the past quarter 
there had been three cases of small-pox, with one death at 
South Boardman, Kalkaska county, the infection of which is 
supposed to have been brought from Denver, Colorado. 

Many outbreaks of diphtheria had been reported during 
the quarter. During the serious outbreak in Kalamazoo, from 
July 20 to December 20, 1884, over two hundred and sixty cases 
and fifty-four deaths from diphtheria were reported to the Kal- 
amazoo bnard of health. The health officer of Kalamazoo 
reported December 22, 1884, that the epidemic in that city 
appeared to be nearly or quite at an end ; but since that report, 
and following the ihnu\ there was a sudden increase of diphtheria 
in Kalamazoo, twenty cases being reporte^d in one week. New 
cases of diphtheria continue to be reported from Detroit at the 
rate of about thirty-five to forty-five per week. The total num- 
ber of cases in Detroit for the year 1884, as collated from the 
weekly reports of the health officer, is over one thousand three 
hundred; and the number of deaths for tte same period is 
over three hundred and forty. 



60 MICHIGAN STATE BOARD OF HEALTH. 

The secretary's reports of the Conferences of State Boards of 
Health held at Saint Louis, in October, and at Washington, in 
December, were ordered to be printed in the Annual Report 
for 1885. 

A letter from a gentleman in Bronson, in regard to sickness 
in his family supposed to be due to arsenic in the wall paper 
of the house, was read by the secretary, and specimens of the 
paper were shown. The paper was sent to Professor Vaughan, 
of Ann Arbor, to have it tested for arsenic. 

Dr. Avery, as chairman of the special committee, — appointed 
at the request of the State Board of Ck>rrections and Charities, — 
to examine the State House of Correction at Ionia, read his 
report. It was accepted and ordered printed in the Annual 
Report for 1885, and copies were ordered sent to the commit- 
tees on Public Health of the legislature, and to the Board of 
Corrections and Charities. The committee found the sewerage, 
plumbing, and ventilation in bad condition. The sewer lead- 
ing from that part of the building where the offices are situated 
empties into the basement instead of into the catch-basin near 
the barn, — that is, it empties at the wrong end. There is no 
provision for flushing the sewer except by means of hose and 
hydrant. The sewer has become filled up with garbage and 
refuse. A new sewer should be laid, leading from the basement 
of the office building to the main sewer, for which there is 
ample fall. The plumbing connecting the kitchen, wash-room, 
bath-room, and water-closets with this sewer is in wretched 
condition, and should be replaced with new, with properly 
ventilated soil-pipes and approved traps. The committee con- 
sider the shafts designed to ventilate the cells as an admirable 
arrangement for the equal distribution of poisonous gases 
through all the cells, but can hardly call it ventilation. In 
the shoe shops an attempt had been made to carry out the rec- 
ommendations of a former committee of this Board, by placing 
steam coils in the few shafts put in when the shops were built; 
but the coils were not heated and so were of no aid to ventila- 
tion. No attempt to ventilate the other shops had ever been 
made. In the cigar shop the odor of tobacco and foul air was 
simply intolerable; the committee noted the pallid faces of 
nearly all of the seventy-five or one hundred young men and 
boys in this room. The water closet of each shop has defective 
plumbing, and is unventilated, so that foul odors arising from 
them are permitted to enter the shops. The ventilating flues 
leading from the hospital to the attic are imperfect and are not 
heated. The committee recommended the prompt remedying 
of these evils by the employment of a competent architect to 
make plans and specifications and to superintend the work. 

Dr. Jerome Walker's text-book, "Anatomy, Physiology, and 
Hygiene," was approved by the Board, according to law, for 
use in the schools of Michigan. 



HYSTERICAL AjnfECTtOSB OF CHILDREN. 61 

The following named text-books were conditionally approved 
under a resolution of the Board passed July 8, 1884, which 
stated that because of errors and omissions until such errors 
should be corrected, the books named could not receive the 
entire approval of the Board : 

"Hooker's New Physiology, designed as a Text-book for 
Institutions of Learning. By Worthington Hooker, M. D. 
Revised by J. A. Sewall, M. D. With a chapter on Alcohol 
and Narcotics, 1884." 

"A First Book in Physiology, for the use of schools. An 
Introduction to the Larger Work by the same Author. By 
Worthington Hooker, M. D." 

H. D. Baker, M. D., Secretary. 



ORIGINAL TRANSLATIONS. 



GERMAN LITERATURE, 
Tbahblatkd by J. A. BOBB, Ann Abbob, Michigan. 



CASES ILLUSTRATING HYSTERICAL AFFECTIONS OF 

CHILDREN. 



Repobtsd by FRANZ RIEQEL, fbom Clinical Qiebskn. 



Of the five following cases of lameness, three followed some 
acute disease; and although all these cases had existed for 
quite a long time and many fruitless means of cure had been 
tried, four of them, on entering the hospital, were cured in a 
short time ; three almost instantaneously. 

Case I, — A boy, twelve years old, who had been troubled 
with feverish disturbances and pain in both knee joints for 
eight weeks, attempted to leave his bed four weeks later; but 
found that he was not able to move his legs forward, so that he 
was obliged to use crutches whenever he wished to move about. 
On account of his walking with two crutches, both extremities 
stiffened and flexed at the knees. The knee joints were nor- 
mal, so that when the boy's attention was directed from them, 
they could be easily stretched straight Yet he could not 
walk without the aid of crutches. 

During the passage of a strong induction shock, the boy 
became very much frightened, and in the fright began to walk. 
He was thus permanently cured. Certainly the lameness in 
thi? case was caused by an acute rheumatic affection of the 
joints. There were no symptoms of hysteria, although in con- 
sideration of the sudden cure, the case may be conceded as 
hysterical paralysis and contractura. 

Owe 11. — ^A boy, fifteen years old, was taken with vomiting, 
headache, and pain in the lower bowels; he remained sicK 



62 HVBTEBICAL XtfECTtOlSB OtT OHILDABN. 

from the 14th of May, to July 2, as it was supposed with gastric 
fever. When he first started to walk on recovering, he, without 
losing consciousness, suddenly fell down and was not able to 
rise; he made strong efforts to stand up, but failed at each 
attempt. Slight contractions were developed at both knee 
joints. 

On the 20th day of July, painful induction currents were 
applied to the extremities, when the boy suddenly began to 
walk; and the next day he was entirely cured. This case also 
was considered as hysterical lameness. 

Case III. — A boy, ten years old, was taken with measles in 
the spring, which were followed by bronchial catarrh and 
exhaustion. In October the boy's legs began to weaken and 
the weakness so increased that he soon lost the use of his limbs. 
At the clope of the year, although while in bed, he had full 
control of all his movements; he began to have cramps in all 
four extremities and rotary movements of the buttocks. 

On the 4th of February the electric pencils were applied. y 

The cramps immediately ceased, and after a second application < 

on the same day, the boy was able to walk and remained per- 
manently cured. Several well-marked symptoms of hysteria 
were present in this case. 

Case IV, — A girl, ei<!:ht years old, became suddenly sick with 
pain in back, neck, and both sides. Three days later she also 
had pain in the extremities and head. She lay motionless in 
bed and had to be fed. Five months later she had pain in the 
left foot. At the end of nine months from the beginning of her 
trouble, she was brought to the clinic. Any movement of the 
spine from the first cervical to the last dorsal vertebra gave her 
pain. The upper extremities could only be moved very slowly, 
and when they were moved they trembled very much. I'he 
lower extremities could barely be moved on account of pain. 
She was exceedingly sensitive. The reaction of both currents 
was normal. 

The day after entering the hospital, the child was constantly 
urged to walk. This gave encouraging results, for on the very 
next day she could already walk much belter, and could use 
her upper extremities in eating and drinking. After using the 
faradic current for four days she was completely cured. This 
case presented a pronounced form of excessive hysteria. 

Case V. — A girl, fourteen years old, took sick in February, 
1881. She had a feeling of lassitude and dejection; and had 
an inclination to weep without any apparent cause. A year 
later she had cramps regularly every day until she had twelve 
in a single day ; then she had total aphasia, contractura and 
salivation. 

She entered the clinical hospital in May, 1882. Statw pra- 
esena the day after she entered: She lay in bed with her knees 
drawn up to her abdomen ; fingers flexed ; thumbs turned in : 



OVARIOTOMY— NASAL NERVE. 63 

eyes constantly dosed; lower part of the abdomen drawn in 
very much ; and in some ^l^ces ansethesia. The next day she 
lay in bed perfectly normal. 

By moral treatment and the application of the faradic cur- 
rent, she improved very rapidly. By the Ist of June, with some 
assistance, she could walk about very comfortably, and by the 
Ist of September, 1882, she was completely cured. This case 
was unmistakably an aggravated form of hysteria. 

The speedy and successful results that were obtained in 
these cases were entirely due to the hospital treatment. The 
elimination of the phtients from the bad influence of their 
former situations and surround ing:s, and substituting in its 
place the determined purposes of the hospital physician, brought 
about these happy results. 

OVARIOTOMY IN A CHILD TWENTY MONTHS OLD. 



BY DR. ROEMBR, Berun. 



At the birth of the child the midwife observed a peculiar 
extension of the abdomen. Nine nionths later the parents first 
noticed an abnorm.Ml eondition whic^li they thought was due to 
curvature of the sj)ine, spina dorsi intmrfium. 

On (xamination an easily movable, perceptibly fluctuating 
tumor, whieh also contained resi>ting portions, was found 
extending from the pelvis. The tumor was diagnosed as a cyst 
before the ojh ration. When the child w.is twenty months old, 
a right ovarian tumor, larger than a child's head was removed 
by laparotomy. 

The wound healed by first intention, and the child recovered 
very rajddly without having any fever whatever. 

On mieroscopically examining the lumor. Dr. Israel diag- 
nosticated it a teratom, which consisted chiefly of connective 
tissue with hyaline cartilage. Within the cartihii'inous masses 
were found osteoid tissues, and perfect bones containing mar- 
row cavities. The tumor was composed of one large and several 
smaller cysts. — German Medical Weekly. 



FRENCH LITERATURE, 

TSAVSIATID BT A. B. WHITEHEAD, AMM ABBOK, MXCHIOAN. 



STRKTCHING OF THE EXTERNAL NASAL NERVE. 



Drs. Badal and Abadie, of Bordeaux, propose this operation 
as a means of curing glaucoma. Dr. Badal, in fact, considers 
that it takes the place of iridectomy and sclerotomy. [It seems 
to be useful only in cases in which the bulb was already dis- 
eased, and nothing but the pain gave indication of the need of 
an operation]. 



64 UTXntfc FBOM FRACTURE OF TIBIA. 

The article states that after separating the nerve from the 
vascular tissue surrounding it, it is to be stretched '' to the point 
of breaking." The nerve should be looked for in the vicinity 
of the trochlea of the trochlearis muscle. The tissue must be 
cut through very carefully, to avoid the risk of cutting the nerve 
in two. 

Dr. Abadie does not believe that the operation will replace 
iridectomv, but that it will, in many cases, be of service, as in 
congenital hydrophthalmia, and secondary glaucoma, after per- 
foration of the cornea, and constriction of the iris. 

In cases in which the operation was performed for the last- 
mentioned disease no relief was afforded. 



HOSPITAL REPORTS. 



MICHIGAN STATE HOSPITAL. 



SURGICAL CLINIC. 

UNDER DONALD MACLEAN. M. D., 

Profenor of Surgery and Clinical Surgery in the Uniyersity of Michigan. 

JOHN WM. B08MAN. A. B., CUNICAL Clirk. 



ULCER RESULTING FROM FRACTURE OF THE TIBIA: SKIN 

GRAFTING: CURE. 



Reported by R. G. CAVANAGH. 



M. C, aged forty, Alpena, Michigan; laborer; American; 
admitted to hospital November 10. 

flistory.— On the 14th of February, 1884, the patient had 
his left leg injured by a log falling upon it. When the physi- 
cian arrived, who attended him, the limb was much swollen. 
To reduce the swelling, the leg was placed on a pillow and hot 
water freely applied. Examination revealed a fracture of the 
tibia in the upper third. The fracture was set and carefully 
watched. The eleventh day after injury suppuration was 
detected. A free incision was made through the soft parts at 
the point of fracture, and a large quantity of pus and blood 
evacuated, and a large fragment of bone removed. Balsam of 
Peru was now applied witn the view of assisting the healing 
action of the wound. In two weeks a plaster of Paris cast 
was applied, which was not removed for eight weeks. When 
the cast was taken off, the wound was found to be suppurating 
and several small pieces of slough bone were removed. 

There being a considerable loss of tissue about the wound, 
an attempt was made to restore this by means of transplanta- 
tion. For this end a large piece of integument with underlying 
fascia and muscle was cut from the calf of the right leg and 






fiNCfi017l>R0MA : AMPUTATION OF THE FINGER. 65 

fitted into the wound and retained by several stitches. The 
operation was a failure. The transplanted piece did not live, smd 
was removed in a few days. Dressings oi vasaline, salves, and 
washes were now used. The wound made by the removal of 
the large graft did not heal and has been suppurating and dis- 
charging free quantities of pus. 

Qmdition and Treatment, — The patient appeared before the 
class November 12, when he was unable to walk without 
crutches. His left foot and leg were conriderably swollen and 
he had partial anchylosis of left knee and ankle. The ulcer 
on the anterior side of left leg was about two and one-half 
inches long and about one and one-half inches wide at the 
broadest part. The lower half of this ulcer was healthy and 
on a level with the surrounding tissues ; the upper half was 
unhealthy and depressed, especially at the superior angle 
where there was a cavity about half an inch deep. The ulcer 
on the posterior side of right leg was about one and one-half 
by three-fourths inches, and healthy-looking. Professor Maclean 
found that the fractured bone had firmly united, and recom- 
mended applying skin grafts to healthy part of ulcers, red 
wash to stimulate unhealthy portions, passive movements for 
the anchylosis, and pressure to reduce the oedema. When 
grafting was done the ulcer was dressed once a day with sur- 
geon'e lint covered with oiled silk, over which was placed a 
compress and bandage. On the days when grafting was not 
done, the ulcers were dressed twice with red wash. The oedema 
was reduced by friction, pressure and the hot douche ; and the 
anchylosis was relieved by passive movements made twice 
daily. While in the hospital, the patient had an attack of 
bronchitis and indigestion. He was cured of the latter by the 
use of nitro-muriatic acid, and of the former by sulphate of 
morphia, syrup of tolu, and syrup of wild cherry bark. 

The patient left the hospital January 14, 1885. His two 
ulcers were healthy and nearly healed, the anterior one being 
not more than one-half inch square and almost level with the 
surrounding parts. The movement in both knee and ankle 
was very good, and he could walk quite easily with the aid of 
a cane. He was advised to continue the same treatment at home. 



ENCHONDROMA: AMPUTATION OF FINGER: REMARKS. 



6. G. S., aged twelve; German descent; admitted to hospital 
October 22, 1884. 

History, — When the patient was two or three years of age, 
his parents noticed that the fourth finger of right hand was 
beginning to turn out. This permanent abduction of the little 
finger was found to be due to a hard, immovable, resisting swell- 
ing growing out from the inner side of its first phalanges, 
which pressed the finger out by pressing against the ring finger. 

E 



66 enchondroma: amputation of the itingkk. 

Since that time the swelling has been growing until it has now 
attained to the size of a butternut. About eighteen months ago 
the third finger of the same hand began enlarging and is 
becoming affected in a similar manner. The little finger is now 
fixed in a position that it forms nearly a right angle with the 
hand. 

October 22: The patient shown to the class and examined 
by Professor Maclean, who diagnosed the tumor as an enchon- 
droma, and while the patient was being put under an anaes- 
thetic remarked that this variety of tumors belonged to the 
class of simple tissue growths, and from its situation and 
appearance he could say with a great degree of certainty^ from 
clinical experience, that this growth was composed of pure car- 
tilage. As in this case, these cartilage tumors are nearly always 
connected with bone. They are seldom seen growing from the 
cartilages covering articular surfaces. Cartilage tumors usually 
come from the outer surface, but they may develop from the 
surface that forms the medullary cavity. They are most fre- 
quently met connected with the bones of the iSngers and the 
toes, and usually grow from the sides and not from the upper 
or palmar surfaces. This one is growing from the inner side 
of the first bone of the little finger, and is crowding it away 
from the hand, making a great aeformity, and rendering the 
finger neither useful nor ornamental. 

There are other peculiar features concerning these cartilage 
tumors. No matter how large any individual tumor may 
become, it never involves more than one bone. All the bones 
of a finger may be affected-, and there may be several tumors on 
each bone but more than one bone is never involved in a single 
enchondroma. While cartilage tumors are most commonly 
connected with bone, they are found growing from other tissues 
of the body. Enchondromas are frequently associated with the 
various glands of the body. The testicle and mammary glands 
are quite frequently the site of these growths. The cartilage 
tumors that are found connected with the soft parts, are not 
always true cartilage but consist of the fibrous variety, which 
is commonly mixed with a modified tissue which has some 
resemblance to* the structure of the organ with which it is con- 
nected. Enchondromas do not infiltrate or involve the struc- 
ture of the part, but grow out from the surface. This fact 
would lead the surgeon to think that the removal of the tumor 
alone would be all that was necessary to prevent its return. 
Clinical experience has shown that tnis is not sufi&cient. It 
would be an easy matter to cut this tumor away from the bone, 
but it would be most certain to return. The only amenable 
treatment is amputation, which I shall now perform. 

After dissecting away the skin you see the form of this 
growth is quite typical of cartilage tumors; they are generally 
rounded and smooth, and in most instances are enclosed in a 



1 



Medical LEGtBLAttoN. 67 

distinct capsule. When cut into, it is seen that the tumor is 
firm and hard, but it does not have the uniform density of 
normal true cartilage. There are small places where the tissue 
seems to have undergone some degenerative changes. These 
spots are softer and are filled with a clear jelly-like substance. 
This is characteristic of the course of these growths. If allowed 
to remain they go on growing indefinitely, and after attaining 
a large size, they take on degenerative changes. In enchon- 
dromas connected with the testicle or growing in the lung, this 
degeneration may result in a sarcomatous tissue, and the tumors 
finally become malignant; or they may have a semi-sarcoma- 
tous structure from the beginning, being mixed with mucous, 
granular and cancer cells. Such tumors are particularly fre- 
quent in the testes, ovaries, mammary and salivary glands. 
They grow very rapidly, and may cause the formation of can- 
cerous degenerations in the surrounding structures. Those con- 
nected with bone are less liable to undergo d^enerations. In 
rare instances they change to bone which is deposited through 
the tumor in granules or it forms a shell; calcification is, how- 
ever, a more frequent secondary formation, but a malignant 
change is rarely seen in an enchondroma connected with Done, 
and it is strange that having so slight a tendency to malignancy 
they should persistently return when removed. This can only 
be explained from the theory that they are developed from 
cartilflLge cells, which are scattered through the bone and which 
have in some mysterious manner retained their embryonic con- 
dition, and power of multiplication and growth. Even the 
removal of the part of the bone, to which the base of the tumor 
is attached, does not prevent a return, and we know from expe- 
rience that nothing snort of the taking away the entire bone 
results in a cure. 



EDITORIAL PERISCOPE. 



MEDICAL LEGISLATION. 



The notice given and the reading of a bill before the State 
Senate, by Senator Hawley, to be introduced by him, for the 
abolition of the College of Homoeopathic Medicine in the Uni- 
versity, and the establishing of a separate college in some other 
city, is the fulfillment of a prophecy made by those members 
of Ihe faculty of the Department of Regular Medicine and 
Surgery who could not be forced by certain influences to resign 
their respective positions when the said law for '' establishing a 
homoeopathic medical college in Ann Arbor as a branch of the 
University of Michigan" was passed in 1875. It was then 
declared that the establishment of such an institution would 
in no wise compromise the '^old school,^' and that a school 



68 CREDIT NOT GIVEN — DtSEASES OF GHItDR£:N. 

representing a system of medicine founded upon a theory so 
imaginary and unscientific, and teaching a doctrine so absurd 
and infinitesimal, could not long exist when in close compari- 
son with the methods of regular and scientific medicine. 

Nine years ago this medical branch of the university started 
out with a *' sounding of trumpets and a flourish of banners. '^ 
The term of 1880-81 there were eighty-eight students; the fol- 
lowing year a class of twenty-three was graduated. For the 
present term thirty-four students are registered and at present 
a graduating class of eight. As the faculty of this school has 
never been known to reject a candidate for graduation, it will 
manifest its usual care and will see that this number is not 
diminished by any act for which it is responsible. 

While we do not believe that Senator Hawley's bill will ever 
pass the committee, it has done all the good it is capable of 
doing, by calling the attention of the state authorities and of 
the tax-payers to a parasite that is annually destroying ten to 
fifteen thousand dollars of the educational appropriations. 

The claim and argument favoring the bill, that there is not 
room in Ann Arbor for two medical schools, is true, and like all 
other truths, it contains a moral: That advocates of false doc- 
trines flee from the light of truth. 



CREDIT NOT GIVEN. 



The London Lancet for December 6, 1884, contains an edito- 
rial note on " Medical Education in the United States." It quotes 
from the report of General Eaton, Commissioner of Education, 
and comments that "The great evil there, is as here, only 
greater — the number of competing schools and the tendency to 
lower or dispense with the entrance examinations." This state- 
ment is only too true, but in the enumeration of the few schools 
of medicine in the United States that have entrance examina- 
tions it fails to mention the department of medicine and sur- 
gery of the University of Michigan among the number. Ten 
years ago entrance examinations were required by this institu- 
tion and each succeeding year they have been made more strict. 



THE VALUE OF CERTAIN SINGLE SYMPTOMS IN THE TREAT- 
MENT OF DISEASES OF CHILDREN. 



Dr. Pallizer does much to relieve the embarrassment and 
remove the conscious feeling of ignorance and helplessness 
shown and felt by the young and uninitiated practitioner in 
examining and subscribing for sick infants, by contributing 
(^London Medical Record) valuable guiding hints drawn from his 
ripe experience. The single symptoms enumerated are pathog- 
nomonic in many cases, and in others are important for their 
great aid for diflbrential diagnosis. 



TKBATMENT OF DISEASES OF CHILDREN. 69 

The first symptom is a strongly marked nasal or palatal cry. 
This is present in, amongst other complaints, syphilitic ozsena, 
hypertrophied tonsils, and paralysis of the soft palate; but 
where these can be excluded, it affords very strong presumption 
of retro-pharyngeal abcess. Dr. Pollizer relates that on one 
occasion he was examining a child, when the nurse passed 
through the room bearing another, four months old, in her 
arms. On hearing it give the nasal cry he stopped the nurse, 
but the mother affirmed that the baby was quite well. Pollizer 
introduced his fingers and found the expected swelling. This 
was incised, and a quantity of pus evacuuted. 

The second symptom is an excessively prolonged, loud- 
toned expiration, with normal inspiration and without dyspnoea. 
This is an early symptom of chorea major, and may precede all 
other manifestations of the complaint. The author mentions 
that he was once called to see a case of supposed croup, but on 
observing this peculiar breathing he felt no hesitation in diag- 
nosing chorea. The mother had observed this symptom about 
two hours, and stated th^t it appeared quite suddenly, when 
the child was apparently well and asleep. The next day he was 
informed that this breathing continued for another hour, and 
then gave place to a singing semi-delirium. 

The third single symptom is that of a high-thoracic, contin- 
ued sighing inspiration. The author regards this as almost 
pathognomic of weak heart, and of certain cases of acute fatty 
heart. The breathing differs from that of croup and other 
stenoses in that, while the diaphragm is almost passive, the 
accessory muscles of inspiration are in vigorous action. The 
symptom is of especial value because it is early, and furnishes 
an indication for treatment long before the other signs — such as 
cyanosis, etc., show themselves. 

Another single symptom is the presence of a pause at the 
end of expiration. This serves to distinguish between laryn- 
geal catarrh and croup, and when well marked, positively 
excludes the latter. In examining for it the room should be 
perfectly quiet, and the ear should be placed close to the 
patient's mouth. The author relates how he succeeded in diag- 
nosing laryngeal catarrh from the mere presence of these pauses, 
in a child who had been ill three days with stenotic breathing, 
hoarseness, and great somnolence. The laryngoscopist who was 
called in confidently expected to find false membranes, but 
none were visible, and the child was well in a few days. 

Another symptom of which it is important to understand 
the significance, is the so-called respiratro-stridula. It consists 
of a slightly noisy, but otherwise normal, inspiration, and a loud 
bleating, interrupted (staccato) expiration; it continues day 
and night, sleeping and waking, with very rare free intervals 
of ten minutes to a quarter of an hour. It commences soon 
after birth, and lasts from eight to twelve months. To the phy- 



70 TREATMENT OF DISEASES OF CHILDREN. 

sician unfamiliar with the condition it appears to be a serious 
matter, and to demand active measures; but it involves no 
dyspncea, and does not affect the nutrition or development of 
the child : moreover it is very obstinate to treatment, and ulti- 
mately ceases of its own accord. The author regards it, there- 
fore, as being within physiological limits, and recommends no 
treatment. 

The next series of symptoms relates to the brain, and the 
first is a remarkable drownsiness, which makes its appearance 
without fever or other disturbance, and exists for some time. 
Pyrexia from any cause is enough to produce drowsiness in a 
child, but when the latter coincides with a normal temperature 
and continues so from twenty to forty hours, it become a val- 
uable symptom of commencing brain disease; and the same 
holds good when the drowsiness sets in upon convalescence 
from fevers when the pyrexial stages are passed. The only 
other conditions which can produce this apyrexial drowsiness 
are narcotic poisons and uraemia, but it is easy to differentiate 
these. 

Another symptom of great value in the early diagnosis of 
brain disease is a very elevated, incompressible anterior fontan- 
elle. This indicates not only increase in the contents of the 
skull, but also that the increase is due to something more dan- 
gerous than hypersemia. It is more valuable when the child 
IS wasted from any cause. When the swelling is so great as to 
resemble a wedge, and no trace of pulsation is present, the dis- 
ease is probably intermenineeal haemorrhage or purulent men- 
ingitis of the convexity. The next series of symptoms relates 
to the character of the cry. 

. (1) A violent, shrill cry, lasting two or three minutes, 
marked by anxious expression, and occurring about an hour 
after the ciiild has gone to sleep, and repeated night after night, 
is probably due to the action of dreams on an irritable nervous 
system. It can be cured by a full dose ot quinine an hour 
before bed-time. 

(2) A cry lasting frequently from five to ten minutes, and 
recurring periodically several times in the twenty-four hours, 
indicates, more especially if dysuria have been observed, spasms 
of the bladder, and can be cured by belladonna. 

(3) The cry accompanying defecation indicates, as is well 
known, fissure of the anus. The author says nothing of opera- 
tion for this and recommends aperients and ointments. 

(4) A violent, almost continued cry, the hands grasping the 
head, which is rolled round and round and buried in the pil- 
low, in little children indicates otalgia. 

(5) A cry lasting days or weeks, increased on movement, 
and associated with profuse sweating and fever is rare, but may 
indicate acute general rickets. 

(6) The cry assopiated with chronic sleeplessness is difficult 



PHYBIOLOGICAL ACTION OF DIGITALIS. 71 

to relieve, though it frequently seems to have no bad eflfect on 
the child's nutrition. In some cases it seems to be inherited, 
as one of the parents is often subject to insomania or hsemi- 
crania. 

The next series of single symptoms have no particular inter- 
dependence. Among them are the following: 

(1) Callapse and immobility of the nostrils generally indi- 
cate hypertrophy of the tonsils. 

(2) A weakness and immobility following a short illness, 
and out of all proportion to such a cause, is very frequently the 
first symptoms of infantile paralysis. 

(3) A single symptom of importance in a condition which 
is generally devoid of symptoms, is the habit of perpetually 
placing the hands before the face. 

(4) A stiffness of posture and gait with a pained expression 
on changing position, is an early symptom oi spondylitis. 

(5) Obstinate vomiting after every kind of food, and lasting 
for weeks, indicates, in a child whose fontanelles are closed and 
whose cranial circumference is large, the supervention of acute 
upon chronic hydrocephalus. 

The author, in conclusion, gives the oft repeated warning 
against diagnosing a disease from a single symptom — a pathog- 
nomonic symptom being rare. He claims for his observations, 
where these are original, the merit of aiding diagnosis at a stage 
when treatment is apt to be of benefit. 



THE PHYSIOLOGICAL ACTION OF DIGITALIS. 



In the October issue of the American Journal of Medical Sd- 
ences, Dr. Samuel Nickels, of Cincinnati, summarizes the pres- 
ent state of our knowledge of the physiological action of digi- 
talis, and his paper is specially instructive since the doctrines 
now universally taught regarding the action and uses of digi- 
talis differ in a number of important points from those held two 
decades ago. Then we were taught that digitalis is essentially 
a sedative affecting strongly the nervous system, thus causing 
feeble and slow heart action. Now the latest authors teach 
that the nervous system is only secondarily affected, while the 
heart is directly influenced, its action becoming more poweiful 
though slower. Twenty years ago we were taught that digi- 
talis is a diuretic directly acting upon the kidneys thus pro- 
ducing in many diseases a greater secretion of urine. To-day 
we are told that digitalis does not act upon the kidneys, at all, 
and only secondarily affects the secretion of urine by causing 
a change in the systemic. In one point, there is aisastrous 
effects and that these may occur quite unexpectedly in conse- 
quence of cumulative action. But not only in regard to the 
mjodus operandi do present authors differ from their predecessors 
but also as to the therapeutic indication. Two decades ago 



72 QUEBIES. 

digitalis was held to be indicated when the heart's action is too 
powerful; now we are informed that it is useful only when the 
heart's action is too feeble. Then author's taught that digitalis 
will control and hence favorably influence a hypertrophied heart, 
vihile present writers contend that every disease of the heart 
attended with excessive action is aggravated. It was held for 
a century, that digitalis, though not eminently useful is still 
often of great service in dropsy dependent upon organic diseases 
of the kidneys; but now we hear that in diseases of the kid- 
neys attended with diminished diureses, it is almost always 
useless and always exceedingly dangerous. 



QUEBIES. 



The following questions are asked in the Canada Lancet by 
a correspondent of that journal. There is nothing in them that 
is new to the practicing physician ; but they are pointed, and 
direct attention to the correction of some common faults, and to 
practices that do not benefit the profession : 

Why are there so many physicians engaged in other employ- 
ments outside of their profession, who delight in a semi-philan- 
thropic practice to the discouragement of others who endeavor 
to excel in, and who live solely by, their profession? 

Why are there so many among us who, in consideration of 
their length of practice, seem to deem it an honor to subscribe 
to the virtues of ** Domestic Medicines," "Every man his own 
Doctor," "Household Physician," and similar works? 

Why is it that now and then a physician in good health, 
and doing (as he says) a three or four thousand dollar a year 
practice, will accept a position which brings in one-half or less 
of the above? 

Why do some physician-druggists allow themselves to act as 
venders of such remedies as " Sir James Clarke's " and " Lady 
Huntingdon's " female pills, which are directed to be used with 
caution (?) at certain times? 

Why do ministers of the gospel whom we, as a rule, attend 
without any pecuniary reward, whenever occasion presents 
itself at the bedside of one of their flock, interfere with the 
instructions of the physician, or tell about some similar cases 
wherein difierent treatment was beneficially used? 

Why is it that among these same reverend gentlemen there 
exist some who, without admitting any medical knowledge or 
having pursued medical studies, insult the regular profession 
with announcements of some specific " croup and diphtheria " 
compound, life saving pill or compound ? 

Who is to blame for the ignorance existing among the pub- 
lic in regard to the distinction between patent medicines and 
well established therapeutical preparations, and where is there 
a man outside the fraternity or drug business who understands 



EFFECT OF NEW DISCOVERIES. 73 

why we prescribe Syrup Hypophosphite Compound (Fellows) 
and not ''Dandelion Blood Purifier"? 

Do our young physicians go to Europe for extra degrees or 
extra knowledge? 

Are not our nauseous and muddy mixtures advancing the 
interests of homoeopathy and patent medicine business ? 

Why, as a rule, do many of our town and village brethren 
keep such filthy offices, filthy bottles of all sizes, colors and 
shapes (pickle bottles are not uncommonly noticeable) when 
they know that neatness, cleanliness and order pay well ? 

An' then a' doctors' saws and whittles 
Of a' dimensions, shapes and mettles, 
A' kind of boxes, muRs, an' bottles. 

He's sure to hae ; 
Their latin names as fast he rattles 

As A B C. 

Is there a physician of several years practice who will deny 
the utility of a series of lectures to a graduating class pertaining 
to the ordinary duties and obligations of the profession itself, 
and the public — and other minor details of a purely practical 
and business order, which many of us have learned by sad 
experience and needless expense? 



EFFECT OF NEW DISCOVERIES . 



Near neighbors should have a reciprocal interest in each 
others misfortunes and successes. It is not a feigned evidence 
of regret that we manifest at the rapid decline of a once flourish- 
ing medical institution. There is produced a feeling of sad- 
ness, as we observe the petals that once formed the flower of 
this most tenderly nurtured plant, emblematic of unquestioned 
faith in infintesimalism, silently drop from their once succulent 
receptacle. This sudden turn in its thrift leads us to inquire 
the cause of this premamature decay. As near as we can find 
out it must be due to a preter-natural "forcing," resulting from 
the discovery of a new and powerful tonic and the infallible 
remedy for cholera; or the unfortunate occurrence of accidental 
homicide from the adulterations of their triturate, accounts of 
which, with comments, are taken from the New England Medical 
Monthly, 

The Homceopathic Kindergarten may well congratulate 
itself upon its tireless activity in the field of medicine. Three 
more priceless discoveries have just been added to its venerable 
and antique collection. It is difficult to say which of these 
contributions to science will prove the most valuable to the 
medical profession. Time only can decide. 

Professor Jaeger, of Austria, has discovered a new tonic which 
bids fair to outrival all other invigorating drugs. It consists of 
a homoeopathic attenuation of human hair in granules. One 



74 EFFECT OF NEW DISCOVERIES. 

of these granules administered tri-weekly is said to exert a won- 
derful tonic as well as detergent effect upon the organism. In 
certain extreme and desperate cases the dose may be increased 
to one granule per day, without producing any toxic effects. It 
will be seen that although the professor has, with apparent 
frankness described his discovery, he has, for reasons of his 
own, neglected to give the degree of attenuation in which he 
exhibits the remedy. This, of course, prevents the profession 
from taking advantage of his discovery. It is safe to say that 
the physician will await these further results with feverish 
anxiety. The long experience in boarding-house life which the 
professor has enjoyed, renders him a high authority on all mat- 
ters pertiining to the natural history and therapeutics of this 
druor, and is an evidence of his thorough familiarity with the 
subject which he treats. 

Another not less important contribution to science is the 
discovery that all sugar of milk contains large amounts of iron, 
silica and aluminum — enough at times to make the sixth 
decimal potency of these drugs. It would be diflBcult to esti- 
mate the disastrous effects which might ensue were poisonous 
drugs present in such amounts. 

Perhaps, indeed, the numerous failures attributed to homoe- 
opathic methods are really due to this fact, supplemented, of 
course, by the usual amount of ignorance on the part of the 
practitioner. In the preparation, therefore, of these high po- 
tencies, the new school cannot be too zealous in procuring 
some menstrum which is absolutely pure. In this profession 
perfection evidently lies in conscientious attention to details 
alone. 

It is with feelings of mortification that we learn the fact, 
that to a member of the same school belongs the credit of hav- 
ing discovered a remedy for cholera. In comparison with his 
investigations, those of Koch, Pasteur and others fade into 
insignificance. A Dr. Herring has established the fact that a 
half drachm of the flowers of sulphur worn in each stocking is a 
sure preventative of this disease, and that one clad, as it were, 
in his sanitary armor, may walk unscathed through the very 
hot-beds of this disease. Any lingering doubts as to the efficacy 
of tthis method are dispelled by the fact that the doctor, who 
liv es somewhere in England, has not had for the past six 
months a single death from cholera in his practice. A large 
number of the Egyptians, who, unfortunately, had no stock- 
ings, and were therefore unable to apply the remedy, succumbed 
to the disease. If the doctor could succeed in making this rem- 
edy of more general utility, we believe it would prove a great 
boon to mankind, but as it is, a very large proportion of the 
inhabitants of those countries which keep cholern germs under 
constant cultivation are practically unable to take advantage 
of this remedy. 



CONDENSATIONS. 75 

Homoeopathy is becoming one of the monuments of our civ- 
ilization. Like the p\Tamid or sphinx, there seems to be no 
good reason for its existence, except as a diversion for great 
minds and a religion for weak ones. Dr. Holmes has cruelly 
said that it furnishes immense returns of fiction for small 
investments of facts — yet one who succeeds in keeping abreast 
of the great discoveries, of which the above are fair samples, 
must think, that perhaps, after all, the professor was wrong — 
that he stated the case too mildly. 



CONDENSATIONS. 



Sir T. Spbncer Wells publicly urges the claims of crema- 
tion as a practical measure of sanitation. 

Dr. Klein still lives after swallowing a dose of Dr. Koch's 
cholera bacillus. Even a large number of commas do not 
make a full stop. 

Dr. Squibb suggests that nauseous salines are best taken 
with ice-water. Take a mouthful or two of ice-water before 
and after the dose, which should be taken in ice-water. 

Secretary McCuli^ch has issued a circular which provides 
that hereafter all old rags, imported from foreign ports, must 
undergo disinfection before being admitted to entry into this 
country. 

The .power of health boards to take charge of or destroy 
property in cases of infectious diseases is a matter of great pub- 
lic importance, and the courts should sustain such boards in 
the proper use of it. 

Dr. Skxton, of New York, in a clinical lecture, called atten- 
tion to the fact, though generally known, but too frequently 
overlooked, that earache and inflammation of the ear, are, 
among the poor, in many instances, due to simple otalgia from 
dental caries. 



Diphtheria is not now believed to be a sewer disease. In 
deductions drawn from the papers of the Collective Investiga- 
tion Society of England upon that disease, less than one-tenth 
of the number of cases are supposed to arise from sewer or bad 
drainage. The disease is epidemic and sporadic. 

Dr. a. Huohes Bennett says that according to the respect 
with which the physician treats his own calling, and the cour- 
tesy and forbearance he exercises towards his colleagues, so will 
he raise his profession in the eyes of the world. Just as his 



76 CONDENSATIONS. 

relations with the public are dignified and honorable, so will 
he elevate himself above the adventurer and the charlatan. 



Since the Cincinnati medical schools have required an 
entrance examination the number of students have diminished 
about thirty per cent. This will be rather hard on the schools, 
but a good thing for the profession. 

Do you profit as much as you should from our advertise- 
ments? Space is given to none but reputable, and well-known 
establishments. Many of them offer to send samples of their 
articles. You should take the benefit of the generosity. It is 
your duty to personally investigate before favoring or condemn- 
ing a preparation. 

The word '* microbe," now so commonly used, was coined 
by M. Charles Sedillot, of Strasbourg, in February, 1878, in a 
paper which he read on the application of M. Pasteur's discov- 
eries to surgery. Coming irom the Greek words miJcros, small, 
and bois, life, it aptly describes the thing intended. In reply- 
ing to M. Sedillot, M. Pasteur used the word twice, and scien- 
tific men have since generally adopted it. 

The Committee on Organization of the next International 
Medical Congress, which is to be held in Washington, Dis- 
trict of Columbia, in 1887, has been constituted as follows : Drs. 
Austin Flint, Sr., New York; I. Minis Hayes, Philadelphia; 
Lewis A. Sayre, New York; Christopher Johnson, Baltimore; 
George Englemann, Saint Louis ; J. S. Brown, United States 
Navy; J. S. Billings, United States Army. 

The Detroit Lancet is authority for the following medico- 
legal information: That a suit for malpractice cannot be enter- 
tained by the court, if previously a bill for services has been 
collected through a suit at law. The question of malpractice 
has been decided in the negative by the court deciding that the 
service must be paid for. Hence a surgeon may prevent a suit 
for damages by previously suing for his services. 

In the early stage of tonsilitis bicarbonate of soda will fre- 
quently relieve the pain and arrest the inflammation. It can 
be applied by the patient himself, by moistening the tip of the 
index finger and dipping it into the dry salt, and, then carrying 
the finger into the mouth and rubbing the soda over the 
inflamed tonsil. Repeated applications are to be made at 
intervals of five minutes. After five or six applications the act 
of swallowing will be nearly painless. A thorough use of the 
soda early in the disease will abort the attack and promote 
resolution. 



Nt:W PUbLICATIONS. 77 

A CONVENIENT battery, one that is not always leaking acid, 
and constantly getting out of order, and can at all timies be 
carried, is a rery desirable article to the practicing physician. 
We find these qualities are all possessed by the Improved 
American Pocket Battery. It produces a current sufficiently 
strong for all medical purposes, and at the same time is con- 
venient and can be carried with perfect safety. While it does 
not take the place of more powerful instruments, it meets the 
average needs of the physician. 

A TUMOR was removed from the brain of a man in the Hos- 
pital for Epilepsy and Paralysis, London, on November 25. 
For three weeks the patient continued to recover, remaining 
perfectly well in body and mind. He was then seized with 
meningitis and died exactly four weeks after the operation. A 
point of great interest in this case is, that the existence and 
location of the tumor was diagnosed from subjective symptoms ; 
paroxysmal tremors commencing in the face and tongue, and 
subsequently involving the arm and leg of the left side, followed 
by paralysis of the arm and weakness of the leg. In addition 
to these symptoms he had double optic neuritis, and suffered 
from attacks of violent pain in the head and uncontrolable 
vomiting. These symptoms led to the belief that a tumor of 
limited dimensions would be found in the cortical substance of 
the brain at the upper part of the fissure of Rolando, which 
was verified by the operation. 



NEW PUBLICATIONS. 



VISIONS OF FANCY-A POETICAL WORK. By N. M. Baskett, M. 
D., Saint Louis, Missouri. Commercial Printing Press, 1884. 

This little work of miscellaneous poems contains many 
pleasing verses and some true poetic tnought. Coming from 
the pen of a doctor, engaged in active practice, where there is 
nothing to excite either fancy or imagination, the versification 
is in a high degree creditable. 



A MANUAL OF BANDAGING. By C. Henri Leonard, A. M., M. D., 
Professor of the Medical and Surgical Diseases of Women and 
Clinical Gynsecology in the Michigan College of Medicine ; Mem- 
ber of the American Medical Association, of the Michigan State 
Medical Society, of the Wayne County Medical Society, and 
Honorary Member of the Canada Medical Association. Second 
edition, revised and enlarged, with one hundred and thirty-nine 
engravings. One hundred and sixty pages, octavo ; cloth; piice, 
$1^, post-paid. The lllustarted Medical Journal Company, Detroit. 

We are pleased to note that a second edition of this estimable 

little work is out. The many students and i)ractitioner8 who 

are familiar with the first need not be further informed regard- 



78 NEW PUBLICATIONS. 

iug the second edition, than that it has been enlarged by much 
new matter and new illustrations. Important additions have 
been made to the chapters on "Bandages of the Lower Extrem- 
ities," '^ Bandages of tne Upper Extremities," and "Immovable 
Dressings." 

The work is designed to meet the wants of medical students 
and practitioners, by furnishing self-instruction on surgical 
dressings and bandaging, and it accomplishes that object. 



DRUGS AND MEDICINES OF NORTH AMERICA. A quarterly 
devoted to the Historical and Scientific Discussion of the Botany, 
Pharmacy, Chemistry and Therapeutics of Medicinal Plants of 
North America, their Constituents, Products and Sophistications. 
J. N. Lloyd & C. G. Lloyd, Cincinnati, 1884. 

The third number of this handsome and valuable quarterl}' 
has in no way deteriorated in any of the points of excellence 
which characterized those previously published. Each plant 
considered is accompanied with finely executed plates illustrat- 
ing its botanical and microscopical structures. The journal is 
a valuable addition to the literature of plants indigenous to this 
country. The three numbers published contain articles on: 
Clematis Virginiana (virgin's bower); Thalictrum Anemonoides 
(rue anemone); Thalictrum Divicum (meadow rue); Anemone 
Nemorosa (wind flower); Anemone Pateus (American Pulsa- 
tilla); Anemone Hepatica (liver leaf); Ranunculus Bulbosus 
(crowfoot); Caltha Palustris (march marigold); Hydrastis Cana- 
densis (golden seal). 

The text and plates show careful preparation ; the engrav- 
ings are accurate and particularly well executed. Considering 
the labor entailed, and elegance of paper and press work, the 
quarterly can meet with no objection regarding price, and at 
the low rate of one dollar per year will have many appreciative 
readers. 



MATERIA MEDICA AND THERAPEUTICS : AN INTRODUCTION 
TO THE RATIONAL TREATMENT OF DISEASES. By J. 
Mitchell Bruce, M. A., Aberdeen, M. D., London; Fellow of the 
Royal College of Physicians ; Physician and Lecturer on Materia 
Medica and Therapeutics, Charing Cross Hospital; Assistant 
Physician to the Hospital for Consumption, Broinpton. 12mo; 
five hundred and thirty-eight pages. Philadelphia: Henry C. 
Lea's Sons & Co., 1884. 

The arrsCngement of this book is a change from the usual 

?lan of therapeutics. The book is divided into three parts, 
art I takes up the Inorganic Materia Medica. Part II, the 
Organic. Part III, General Therapeutics. 

The name of each drug is given in Latin and in the 
English, its chemical formula and the definition, its nature, 
its source, its character, its composition, its doses and the 
preparations made from it. The work is devoted mainly to 



NKW PUBLICATIONS. 70 

therapeutics. The plan adopted by the author in the descrip- 
tion of the Special Therapeutics, "consists in systematically 
tracing the physiological action and uses of the different drugs 
in their passage through the body." The immediate local 
action of the drug, both externally and internally, and uses, 
are first given; its action on the blood and uses; specific 
action and uses ; remote action and uses ; action and uses of 
the different preparations are respectively considered. 

This little work is especially designed for students. It is 
admirably arranged for graded study, the Materia Medica 
being printed in larger type that the text devoted to Therapeu- 
tics can be easily selected out by first year students. 



A PRACTICAL TREATISE ON FRACTURES AND DISLOCATIONS. 
By Frank Hnstinjrs Hamilton, A. B., A. M., M. D., LL. D., late 
Profeasor of Surjrery in Bellevue Hospital Medical College, and 
Surgeon to Bellevue Hoepital. New York ; Consulting Surgeon to 
Hospital for Ruptured and Cripples, to Saint Elizabeth Hospital, 
etc.; author of a Treatise on Military Surgery and Hygiene, a 
Treatise on the Principles and Practice of Sur^rery, etc. Seventh 
American edition, revised and improved. Illustrated with three 
hundred and seventy-nine wood-cuts. Octavo; one thousand and 
five pages. Philadelphia: Henry C. Lea's Son & Co.. 1884. Geo. 
OsiuB & Co., Ann Arbor, Michigan. 

This treatise on Fractures and Dislocations, which is a text- 
book and book of reference to medical student and practitioner, 
is so well known, that it needs no words of praise. During the 
twenty-five years of its publication, there have been seven 
editions printed, each one carefully revised and greatly enlarged, 
and during this time it has not only held its own, but has con- 
stantly grown in favor. The edition now before us has much 
new material, which has been collected from ** the most recent 
contributions to the literature of fractures and dislocations as 
found in the various American and foreign medical journals, 
and in the latest surgical treatises." These numerous additions, 
drawn firom recent recorded facts and observations, together 
with many valuable suggestions which he has obtained from 
his own more recent experience, proportionately increases its 
value. The general "make up" of the work exhibits that 
degree of care in the arrangement of the text that characterizes 
the author, and the high state of perfection of mechanical 
execution that has been attained by H. C. Lea's Son & Co., as 
publishers. 

BOOKS AND PAMPHLETS RECEIVED. 



OFFICIAL REGISTER OF PHYSICIANS AND MIDWIVES (NOW 
IN PRACTICE) TO WHOM CERTIFICATES HAVE BEEN 
ISSUED BY THE STATE BOARD OF HEALTH, OF ILLI- 
NOIS, 1877-1884. Springfield, Illinois: H. W. Bokker*8 Publishing 
House, 1884. 



80 NEW PUBLICATIONS. 

THE SOCIAL HISTORY OF THE EIGHTH INTERNATIONAL 
MEDICAL CONGRESS. HELD IN COPENHAGEN, AUGUST, 
1884. By D. Brysoxi Delavan, M. D., New York. New York: D. 
Apple ton &. Co., 1885. 

CONSPECTUS OF THE MEDICAL COLLEGES OF AMERICA. 
Compiled by the Illinois State Board of Health. Revised to 
December 20, 1884. Springfield, Illinois: H. W. Bokker, State 
Printer and Binder, 1884. 

SIXTH ANNUAL REPORT OF THE STATE BOARD OF HEALTH 
OF ILLINOIS, WITH TWO APPENDIXES. A.— Conspectus of 
the Medical College of America. Revised to December 20, 18S4. 
B. — Official Register of Physicians and Midwives of Illinois. 
Revised to December 1, 1884. Springfield, Illinois: H. W. Bokker, 
State Printer and Binder, 1884. 

A GUIDE TO THE STUDY OF EAR DISEASE. By P. McBride, 
M. D., Fellow of the Royal College of Physicians, Edinburgh ; 
Fellow of the Royal Society of Edinburgh; Surgeon to the Depart- 
ment for Diseases of the Ear and Throat in the Royal Infirmary of 
Edinburgh; Surgeon to the Edinburgh Ear and Throat Dispen- 
sary. J. H. VailA Co., New York, 1884. 

SCHOOL HYGIENE IN RELATION TO ITS INFLUENCE UPON / 

THE VISION OF CHILDREN OR SCHOOL SANITATION. 
An Address Delivered before the Medical Association of Georgia, 
1884. By A. W. Calhoun, President, Atlanta, Georgia. Reprint 
from "Transactions of the Medical Association of Georgia." 
Atlanta, Georgia: Jas. P. Harrison &, Co., Printers, 1884. 

A PHARMACOPCEIA FOR THE TREATMENT OF DISEASES OF 
THE LARYNX, PHARYNX AND NASAL PASSAGES, WITH 
REMARKS ON THE SELECTION OF REMEDIES AND CHOICE 
OF INSTRUMENTS, AND ON THE METHODS OF MAKING 
LOCAL APPLICATIONS. By George Morewood Lefferts, A. M., 
M. D., Clinical Professor of Laryngology and Diseases of the 
Throat, College of Physicians and ~ Surgeons, Medical Depart- 
ment of Columbia College, New York. Second edition, revised 
and enlarged. New York and London : G. P. Putnam's Sons, 1884. 

THE LONDON MEDICAL STUDENT AND OTHER COMICALITIES. 
Selected and compiled by Hugo Erichsen, M. D., recently Professor 
of Neurology in the Quincy School of Medicine, Medical Depart- 
ment of Cbaddock College ; Licentiate of the Royal College of 
Physicians and Surgeons, of Kingston, Canada ; Member of the 
Detroit Medical Library Association ; formerly Assistant Editor 
of the Detroit Clinic; recently Associate Editor of the Wettem 
Medical Reporter, and the Med.-Chir. Correspondent of J3tot</u^ 
DeiUsch'Amerikanische Aerzte, etc. Detroit : The Detroit Free Pre^m 
Company, 1885. 

THE DIAGNOSIS AND TREATMENT OF CHRONIC NASAL 
CATARRH. Three Clinical Lectures Delivered at the College of 
Physicians and Surgeons, New York. By George Morewood 
Lefferts, A. M., M. D., Professor of Laryngocopy and Diseases of 
the Throat in the College of Physicians and Surgeons; Consulting 
Laryngoscopic Surgeon to Saint Luke's Hospital, and the New 
York Skin and Cancer Hospital ; Surgeon to the New York Eye 
and Ear Infirmarv (Throat Department); Ex-President of the 
American Laryngological Association. Reprinted from the Medical 
News, of Philadelphia, April 26, and May 3, 1884, and from Amer- 
ican Clinical Lectures. Volume II, Number VI. Saint Louis: 
Lambert & Co., 1884. 



PERMANGANATE OP POTASSIUM. 81 

MEDICAL DIGEST. 



PERMANGANATE OF POTASSIUM: ITS ACTION AND USES. 



There is a general feeling of uncertaint}' regarding the real 
value of the permanganate of potassium .is a remedy. Sharing 
in this to some extent, and desirous of arriving at definite con- 
clusions, I have undertaken to collect the available evidence. 
This consists, chiefly, of clinical observation, and my own has 
been supplemented bv such published experiences as have 
rewarded my search of authorities. 

The prime objection of contemporary writers is, that per- 
manganate is so quickly decomposed on coming into contact 
with organic matter, that its powers must then cease. I have, 
however, given reasons for supposing that the diffusibility of 
this salt is so rapid, that it has some rtction on the blood. ¥ot 
example: When used locally for the bite of a venomous ser- 
pent, the poison is destroyed, notwithstanding the organic mat- 
ter in which it is enclosed. Before discussing its actions and 
uses, its physical and chemical qualities should be stated. 

According to the United States Pharmacopoeia, permangan- 
ate of potassium occurs in "deep, purple- violet, or nearly black, 
needle-shaped rhombic prisms, of a metallic lustre, permanent 
in the air, odorless, having a sweet, afterward disagreeable, 
astringent taste, and a neutral reaction. Soluble, with the 
exception of a scanty brown residue, in twenty parts of water 
at 59® Fahrenheit (15° cenligrate), and in three parts of boiling 
water." 

According to the new notation, permanganate of potassium 
is represented by the formula KjMnaOs; and to the old, KO.Mn, 
Gt- It is remarKable for the quantity of oxygen which it con- 
tains, and for the readiness with which it yields it up in its 
most active form, or as ozone; — yields it up so readily that it is 
one of the reagents used to determine the presence of organic 
matter in potable waters. This process illustrates one of the 
funtions performed by permanganate of potassium in the human 
economy. The fine purple color of the solution of this salt in 
pure water is quickly discharged when brought into contact with 
organic matter; the oxygen seizes on and oxidizes the organic 
matter, and the permanganate is reduced correspondingly, the 
color changing to a dirty brown. It is this oxidizing power for 
which this salt is now employed as a deodorant and antiseptic. 

The foul odors arising from decomposing organic matter are 
due chiefly to the compounds of hydrogen with sulphur and 
phosphorus — the sulphide and phosphide of hydrogen and 
some other products. The oxygen in its nascent state seizes on 
the hydrogen, and sulphur ana phosphorus are set free, whence 
the destruction of odor. The chemical action which removes 



82 PRBMAN6ANATE OF POTASSIUM. 

foul odors, does not, necessarily, imply the destruction of germs 
and other materies rnorbi. Bacteria, micrococci, and other minute 
organisms, so often associated with the ordinary products of 
putrefactive decomposition, are now known to be the cause of, 
or at least to convey, the poison of some diseases. Active oxy- 
gen, or ozone, or nascent oxygen, has an oxidizing or destroying 
action on some of these pathogenic agents, and nence perman- 
ganate of potassium, whilst a deodorant, is also antiseptic. 

Brought in contact with snake poison it destroys its toxic 
power. Thus, as Lacerda was the first to show, if inserted into 
the wound made by a noxious reptile, the poison is decom- 
posed, and, consequently, has no efiect on the system. Lacerda, 
it is true, supposed that this agent would prove equally eflfec- 
tive when administered by the stomach — that it would antago- 
nize and render harmless the poison introduced at any point; 
but this supposition has proved to be erroneous. The effect oi 
permanganate of potassium on animal poison is chemical; it is 
antidotal, but not physiologically antagonistic; and hence to be 
effective it must be brouglit into immediate contact with the 
poison, which is oxidized and its power thus destroyed. 

Brought in contact with the tissues of the body, permangan- 
ate of potassium has an effect determined by the condition of 
the part. On the unbroken integument external and internal 
(mucous membrane), it does not have an irritant action, but 
the oxygen readily assails the uncovered tissue. It stains the 
skin a brownish color, and applied to an abrasion causes con- 
siderable smarting and burning, and is very superficiallv 
<3austic. In small doses (two or three grains) well diluted, it 
does not irritate the stomach, but if the dose be large and in a 
solution too concentrated it causes local heat, a sense of irrita- 
tion, even burning pain. The efiect of a large dose, insufii- 
<;iently diluted, is, doubtless, chiefly local; but if given in suflS- 
cient water on an empty stomach, difi'usion into the blood 
probably takes place to some extent. 

The systemic action of permanganate of potassium may be 
studied in several modes: the efiect of the salt as a whole; the 
efiects of its chief constituent, active oxygen or ozone. 

It has been alleged that this salt connot act beyond the 
stomach, because there its oxygen must be appropriated by the 
organic matter contained in that organ and tne mucous mem- 
brane, but certain physiological and clinical facts support the 
opinion above expressed regarding it^ diff'usion into the blood. 
Vulpian has studied the efiects produced by this remedy when 
thrown directly into the veins. This mode of experimentation 
is open to many objections. The bulk of the material injected 
into the veins, were it water merely, must, and as we know, 
does have an effect on the functions of the circulatory organs. 
Furthermore, the emboli produced by the chemical action of 
xhe salt on the formed elements and on the fibrin, must of 



PERMANGANATE OF POTASSIUM. 83 

necessity cause serious disturbances at widely separated points 
and in various functions. The results be noted were of two 
kinds, consisting of chemical changes in the blood, and the 
effects of the salt at the points of elimination. In the first cate- 
gory were pulmonary infarctions, dissolved corpuscles, bloody 
urine and ecchymoses; in the second, were congestion of the 
gastro-intestinal mucous membrane, and of the kidneys. Ob- 
viously such experiences are not characteristic, for they follow 
the injection into the blood of various chemical agents. 

As the chief, if not the only therapeutic effects of perman- 
ganate of potassium, are due to its oxygen, it is most important 
to ascertain the effects of this agent. The modem investigations, 
especially those of Demarquay and Hay em, of France; Walden- 
burg, of Germany; Birch and Mackey, of England ; and A. H. 
Smith, of New York, have thrown a flood of light on the actions 
and uses of this agent. More recently the researches of Binz 
on the effects of ozone have been successful in clearing up much 
of the mystery surrounding the physiological actions of this 
peculiar toim of oxygen. The results of the action of oxygen 
thus studied, are quite in harmony with a priori conceptions. 
On the most superficial view, it would be regarded as a vital 
stimulant, and as an agent promoting the activity of the com- 
bustion process in all parts of the body. This notion of its 
actions is supported by investigation made by the various 
observers above mentioned* 

The recent studies of Binz of the effects of ozone, are pecu- 
liarly instructive. He finds that ozone has a hypnotic action, a 
calmative effect on the central nervous system, due, he sup- 
poses, to an impression on the cells of the gray matter, whereby 
their functional activity is suspended. In some trials on his 
own person, he experienced the following results: his respira- 
tion became deeper and more easy and he had that feeling of 
well-being produced in the healthy by the respiration of a 
pure and exhilaratiDg atmosphere. Some drowsiness came on, 
with an agreeable languor, and afterwards there was experienced 
some heaviness in the head (hebetude), together with a general 
sense of fatigue, but no other disagreeable sensations. 

The powers possessed by the permanganate of potassium as 
a general stimulant are well exhibited in the active emmena- 
gogue property which it has been shown to possess by Drs. 
Kinger ana Murrell. In cases of amenorrhoea due to deficient 
activity, it seems to promote the function in a remarkable 
degree. The same power, which can so stimulate the sexual 
functions, must, when exerted in other directions, prove equally 
effective. 

Mode of prescribing permanganate of potassium, —As this salt is 
so readily aecomposed, yielding up its oxygen to any organic 
matter present, it is obviously necessary to be very careful in 
preparing and administering it. It should be given dissolved 



84 P£RMANOANAT£: OF POTASSIUM. 

iii pure water, or in compressed tablets or pellets. I have used 
the compressed tablets of Messrs. John Wyeth & Brother, of 
Philadelphia, which contain no excipient, and are, therefore, 
entirely free from objection, the material being simply com- 
pressed without the addition of any foreign material. They 
are readily administered in this form, or they can be dissolved 
in pure water, whenever a solution is desired. These tablets 
are typically adopted to the purpose — indeed present advan- 
tages not possessed by any other possible mode of adminis- 
tration. 

Ordinary distilled water after standing a few hours exposed 
to the air, begins to exhibit evidences of turbidity, due to the 
growth of an organism, a penicillum, and after some davs it 
becomes so much clouded with organic matter as to be unfit for 
the solution of permanganate of potassium. River water or rain 
water boiled and filtered may suffice for immediate use, but 
whenever it can be obtained, fresh distilled water should be 
employed for this purpose. A pelfet of this salt may be used 
to determine the requisite freedom from organic matter. 
Dropped into the water under examination, the beautiful violet 
color imparted to it should not be discharged. The prompt 
disappearance of the color signifies the presence of chemical 
agencies fatal to the permanence of the salt. The solution 
should be well diluted when taken, and should be given when 
the stomach is empty. A small dose repeated at short inter- 
vals, say a» grain or two eveiy half-hour, until four or six grains 
have been taken, is preferable to the exhibition of this amount 
at one dose. Given in this way, and commencing the admin- 
istration in about four hours after meals, the diffusion of the 
salt into the blood is, probably, secured. There are two periods 
during the day, when the administration of the remedy can be 
practiced — the proper interval after breakfast, and after dinner 
or luncheon. The same considerations should govern the 
administration of the pellets or compressed pills, undissolved, 
and sufiicient pure water should be taken after them. 

Therapeutic applicationa, — On the chemical actions of per- 
manganate of potassium we have a sure basis on which to con- 
struct a systematic therapy. The readiness with which this salt 
pji^rts with its oxygen, is urged against its real utility as a 
remedy, but for reasons already given it is concluded that this 
action does not occur with sufficient promptitude to prevent its 
diffusion into the blood to some extent, otherwise we should in 
vain try to account for its practical utility. 

Having more or less irritating quality, permanganate of 
potassium is contra-indicated in cases of acute inflammation of 
the stomach. It is specially indicated in chronic gastric and 
gastro'inteatinal catarrh^ accompanied by fermentative changes in 
the food. Eructations of gas, vomiting of a yeast-like material 
containing sarcinas, and an acid fermentation of the starchy and 



PERMANGANATE OF POTASSIUM. 85 

saccharine constituents of the food, are relieved often very 
promptly by the administration of this salt. As the action is 
intended to be restricted to the stomach contents, the proper 
time for the administration of the remedy is two or three hours 
after meals. 

When the catarrhal process extends into the duodenum, and 
involves also the bile-ducts, this remedy has seemed to be 
highly efficient. Beside the evidences of stomachal and intes- 
tinal indigestion there is present more or less biliousness, man- 
ifested in a muddy complexion, yellow conjunctivn, high-col- 
ored urine and a general malaise due to the presence in the 
blood of immature materials and unoxidized products of the 
retrograde metamorphosis. This is a very common state of 
things and is the result of several factors: improper feeding, 
catarrh of the gastrointestinal and hepatic mucous membrane, 
and imperfect preparation of the food for absorption. The per- 
manganate, in this condition of things, does good in several 
directions: it checks fermentation of the food elements prone to 
this process, acts favorably on the catarrh of the mucous mem- 
brane, but especially promotes oxidation in the tissues under- 
going metamorphosis, and whilst it thus stimulates metabolism, 
helps to consume in the normal way the products of waste. 
Uric acid which appears in the urine, under the action of per- 
manganate of potassium is converted into urea, the form in 
which it is normally excreted. 

It follows from the foregoing considerations, that perman- 
ganate of potassium is a remedy of great value in lithsemia. 
Clinical experience is quite in harmony with physiological 
deductions. In giving this remedy in this affection, two pur- 
poses may be accomplished by it: the catarrh of the mucous 
membrane and the fermentation of the foods may be favorably 
influenced, and the insufficient oxidation manifested by an 
excess of uric acid in the urine, may be wholly relieved. 

It follows, also, from the foregoing considerations that per- 
manganate of potassium must be useful in an affection cognate 
to lithsemia — the hepatic form of glycosuria, and in this 
instance, again, clinical experience confirms physiological 
observation. The special field of its usefulness in relation to 
diabetes, is in those cases in which there appears to be both 
overproduction of glycogen, and insufficient consumption, or 
comoustion, or oxidation of this material. It will be found 
most beneficial in the obese subjects of glycosuria, in whom the 
presence of much uric acid in the blood signifies at the same 
time inadequate preparation for absorption of certain food con- 
stituents and a supply of oxygen insufficient to convert uric 
acid into urea. In other forms of diabetes, especially of nerv- 
ous origin, permanganate of potassium has no beneficial effect. 

For the same reason that this salt is useful in lithsBmia and 
glycosuria, it is a remedy for obesity. According to the obser- 



86 PERMANOANATB OF POTASSIUM. 

vation of the writer, there is no remedy more eflfective than this 
in the treatment of obenty, and for the relief of the disorders of 
digestion which have a pathogenic relation to this malady. Of 
course, certain changes in the diet must be made and active 
exercise enjoined, but the good effects of the remedy are mani- 
fest without any aid from a change in diet and from exercise. 
The methodu8 modendi, is, so to speak, of the physiological order. 
The surplus and useless material, such as under existing cir- 
cumstances is transformed into fat, is oxidized and consumed, 
and is excreted as carbonic acid and water. As it acts thus, to 
increase the performance of a function, obviously the curative 
effect is an exercise of a physiological power, and different from 
all the usual remedies for obesity, does not operate injuriously 
if used with the least discretion. 

One of the most important therapeutical applications of the 
permanganate of potassium, and a recent discovery, is in the 
treatment of amenorrhosa. We owe this valuable improvement, 
as indeed many others, to Drs. Ringer and Murrell. They have 
shown that this remedy is remarkably certain when applied in 
suitable cases. Given in doses of two to five grains three times 
a day, for several days preceding the menstrual molimen, this 
agent is quite sure to start the flow. The kind of case to which 
the permanganate is adapted is that characterized by torpor, 
ansemia, or deficient activity of the menstrual apparatus. On 
the other hand, it is contra-indicated whenever an acute conges- 
tion or a general condition of stheiiic reaction exists. Confirm- 
atory evidence has been offered in this country, as well as in 
England and on the Continent. For example, we find the fol- 
lowing coming from Russia : Dr. S. M. Lvaff prescribed it in ten 
cases of amenorrhoea. In seven of these the remedy succeeded 
— the menstrual function was restored to its normal activitjr. 
The good results achieved by the use of the permanganate in 
amenorrhoea induced Dr. A. V. Vargunin to essay its adminis- 
tration in dysmenorrhosa^ characterized by scanty menstruation 
and ansemia. In this cane, also, the result was fortunate, and 
complete relief was obtained. Congestive or mechanical dys- 
menorrhoea are conditions not suitable for the action of such a 
remedy. 

It is probable that functional impotence in the male will be 
improved by this remedy, provided the conditions present are 
those of ansemia and depression. 

Topical and disinfectant uses. — Permanganate of potassium 
has long been known as a disinfectant and deodorizer. Since 
the agency of minute organisms, as bacteria, bacilla, micro- 
cocci, etc., in setting up septic processes in the body, has been 
establislied, the various substances employed as disinfectants 
have been assigned to different relative positions, for now the 
important point is to procure the death of the living germs and 
their progeny. An agent destroying foul odors does not neces- 



PEBMANQANATB OF POTASSIUM. 87 

sarily, does not indeed usually, destroy the germs of disease. 

The permanganate of potassium is to be classed with the 
"deodorizers" rather than with the "antiseptics." From this 
point of view it is an " elegant " disinfectant. In an elaborate 
research on the antiseptics and their power to destroy bacteria, 
Bucholtz does not include this salt amongst the list of agents 
possessing the power to destroy bacteria and similar organisms. 
Again, M. Ratimoff in a paper on antiseptics and the results of 
their use in surgical practice, has, also, ignored the permangan- 
ate, not mentioning it amongst those agents that have true 
antiseptic power. The most thorough, and from the modern 
point of view the most scientiffc, treatment of the subject of 
antiseptics is the essay of Dr. Miguel. He assigns permangan- 
ate of patassium to a group containing the salts oi lead, zmc, 
nickel, and cooalt, alum, tannin, the mineral acids, and other 
agents. The first group is composed of "substances eminently 
antiseptic;" the second of "substances very strongly antisep- 
tic;" the third of " substances strongly antiseptic;" the fourth 
of "substances moderately antiseptic;" the fifth of " substances 
feebly antiseptic." Permanganate of potassium, in a list of 
ninety-one agents having qualities more or less antiseptic,. 
stands forty-fourth, the bichloride of mercury being first. The 
important point, however, to be dptermined, in respect to the 
powers of any antiseptic, is its efiects on the vitality of living 
germs or microbes. In the attempt to ascertain this quality of 
any antiseptic, certain precautions must be observed if the 
results are to possess any real value. These precautions have 
been well stated in a memoir of N. Jalan de la Croix, whose 
experimental inquiry was conducted under the observation of 
Professor Dragendorfi". 

Bacteria developed in difierent liquids do not possess the 
same power of resistance to the action of antiseptics ; they resist 
more successfully when contained in their native fluid than 
when in culture solutions. The same facts are true of the 
spores, which are sterilized with more difficulty in their native 
element than when transplanted into foreign fluids. 

Most of the experiments made have been with microbe? 
contained in culture fluids; for example, the very able and 
elaborate research made by Dr. Sternberg. Under the circum- 
stances the results are better than can be achieved from the uj^e 
of the same antiseptics in disease, cceteris paribus, Sternberg 
assigns to bichloride of mercury (mercuric bichloride) the first 
place as an antiseptic; yet he puts permanganate of potassium 
second. Whilst bichloride is effective in the proportion of one 
part in twenty thousand of fluid, the permanganate of potas- 
sium acts to the same degree in the proportion of one part to 
eight hundred and thirty-three of solution. The bichloride is, 
therefore, about twenty-five times more efficient. We must 
acknowledge a certain sense of scepticism in examining these 



88 PERMANGANATE OF POTASSIUM. 

experiments of Dr. Sternberg, as able and well-considered as 
they unquestionably are. We find it difficult to understand 
why liquor zinci chloride has no gernaicide action, whilst a 
two per cent. Folution of the same ia effective in the proportion 
of one part to fifty. As the experiments of Dr. Miguel have 
been more recently performed, and the conditions insisted on 
by Jalan de la Croix more perfectly observed, we may rather 
accept his conclusions in regard to the real value of permangan- 
ate of potassium as a germicide. 

As a deodorant, and so far a disinfectant, this agent has a 
large sphere of usefulness in medical practice. SuflScientljr 
concentrated, it has an effect on the constitution of certain ani- 
mal poisons. The first fact ascertained by Lacerda — that per- 
manganate of potassium decomposes and renders harmless the 
poison of venomous snakes — t^eems to contradict the results of 
the experimental invei?tigations regarding its germicide power. 
The destruiition of the animal poison takes place on contact, 
but the same agent is completely inefficient when acting through 
the whole mass of the blood. It is, however, a question of the 
strength in which the permanganate is used. Topically, it is 
possible to make applications strong enough to decompose ani- 
mal poisons without, at the same time, injuring the textures to 
which they are adherent. 

In gonorrhcBa^ leucorrhma^ and suppurating buboes^ a strong 
solution — ^\Q to ten grains to the ounce — is an efficient remedy 
It has proved to be especially so in gonorrhoea. When the 
attack is recent, the solution should not be stronger than two 
grains to the ounce, but, the more chrouic, the stronger the 
mjection may be made, of course within reasonable limits. In 
suppurating buboes, the contents of the sac should be drawn 
off with an aspirator if still intact, or thoroughly evacuated if 
ruptured, and the cavity filled with the stronger solution men- 
tioned above. 

Lacerda's experience with permanganate in snake poison 
renders it almost certain that in the corresponding poison of 
syphilis the local application of this remedy at the earliest 
moment to an infecting chancre may be productive of the best 
results. In all forms of unhealthy and sloughing syphilitic 
sores — in sloughing phagedsena, for example— it deserves more 
extended use than has heretofore been made. Finely pulver- 
ized, it can be dusted thoroughly over the diseased sm'faoe and 
introduced into all the sinuosities. By the same mode of 
application it can be used in lupus and epithelioma^ and will, 
doubtless, be found more effective than the chlorate of potas- 
sium, which, applied in this way, has lately been much urged 
on the attention of the profession. 

As a disinfectant and deodorant, a solution of two to five 
grains to the ounce is useful in otorrhosa^ ozceaa^ fetid breathy fetid 
sweat of the azida andfeet^ and in general wherever on the surface 



THE PROCEbS OF INFLAMMATION. 89 

of the body there are odorous discharges and emanations. For 
general disinfectant purposes it is rather an expensive agent, 
even if equal to the active and cheaper agents now utilized for 
this purpose. 

Aa has been already stated, permanganate *of potassium is 
the most generally useful test for determining the presence and 
amount of organic matter in potable waters, a standardized solu- 
tion being employed. It may. also, be used to free drinking 
water from dangerous impurities when the drinking of contam- 
inated water may be imperative. — Dr. Bartholow in the Medical 
News, November, 1884. 



A NEW EXPLANATION OF THE PROCESS OF INFLAMMATION. 



In the last number of the Quarterly Journal of Microscopical 
Science there is a translation of Dr, Elias Metschnikoft's paper 
"On the Mesodermic Phagocytes of Certain Vertebrates," origin- 
ally published in the Biologischer Centralblatt. Metschnikoff has 
shown elsewhere that certain amoeboid cells in the tissues of the 
invertebrates have the power of ingesting and absorbing food 
particles. On experimenting with vertebrates, he found that 
the connective tissue cells had the same power, and that, in a 
batrachian larva about to metamorphose, the absorption of the 
tail was brought about by these cells, which he terms "phago- 
cytes." At the beginning of the metamorphosis these amoeboid 
connective- tissue cells collect round the muscles of the tail, and 
gradually devour their fibers. The fragments of muscle retain 
their structure for some time after ingestion, so that the process 
can be readily seen to take place, but gradually lose their stria- 
tion and break up into rounded strongly refracted globules. In 
order to ascertain whether these phagocytes would absorb, and 
so eliminate from the system injurious substances, Metschnikoflf 
injected putrescent blood, so as to induce septicamia. In a 
short time the white blood corpuscles (which are also included 
in the term phagocytes) were seen to contain both still and 
motile bacteria, and these organisms were especially abundant 
in the " hsemophagocytes " or while blood corpuscles of the 
spleen. This fact, taken together with the probability that the 
spleen has no very important physiological function, since ani- 
mals live without much apparant discomfort after its complete 
excision, seems to indicate a prophylactic function for the 
spleen, it being merely a protection against septic bodies such 
as bacteria, the removal of which from the body is its function. 

To apply these facts to the process of inflammation : When 
inflammation was induced in the tail of a newt, the first phe- 
nomenon was the collection of connective-tissue "phagocytes" 
round the injured cells, followed by the passage of " hsemophag- 
ocy tes " or white blood corpuscles through the walls of neigh- 
boring capillaries, both collecting apparently for the purpose of 



90 TREATMENT OF ALBUMINURIA. 

devouring, and so removing the ruptured, de^d and dying cells. 

In fact the essence of the whole inflammatory process may 
be said to be a conflict between the "phagocytes" and the 
septic material, whether the latter be a dead or dyings cell^ 
bacteria or other foreign body. In the invertebrates, where con- 
nective-tissue cells are abundant, the vascular system does not 
participate in the process, only doing so among vertebrates, 
where the extra-vascular "phagocytes" are not sufficiently 
numerous to combat the injurious structures, a call for assist- 
ance being then ^iven to the " hsemophagocytes." The first 
efiect of irritation is on the connective-tissue "phagocytes," the 
changes produced in them subsequently influencing the capil- 
lary walls, and allowing the transit of the white corpuscles. 

The theory has much to recommend it, being founded on 
logical, d 'priori grounds, and affording simple explanations for 
many obscure points in connection with inflammation. For 
instance, it afibrds a simple explanation for the presence of the 
large numbers of connective-tissue and white blood corpuscles 
that have been observed in induced keratitis, and also it ex- 
plains how in certain epidermic fevers — famine fever for in- 
stance — numerous sprilla, etc., can exist in the blood of as yet 
unaffected individuals, without causing any symptoms of the 
epidemic. At the same time the theory is quite compatible 
with all definitely ascertained pathological facts, a circumstance 
which alone would give it considerable weight. — Professor Mc- 
Murri/ih, 



TREATMENT OF ALBUMINURIA. 



Dr. W. R. Thomas, of Sheffield, gave to the British Medical 
Association his views on this subject in the following brief wajr: 

Treatment of Acute Cases. — If we keep in mind that the dis- 
ease has been produced by this excessive work, we shall natu- 
rally try to relieve the kidneys as much as possible. We should 
take care that the skin is kept warm and clean, that its action 
should be increased, if necessary, by warm or vapor baths. 
The bowels should be kept open daily. Only a sufficient quan- 
tity of food should be given, or the kidneys will have too much 
work to do. 

Treatment of Chronic Cases. — I believe that, if we can ascer- 
tain what the cause of the disease is, we do much towards the 
cure. We should, I think, see that excess of food or drink is 
not taken, that the mind is not worried or overworked, that the 
skin and other organs are acting properly, that the kidneys are 
not compelled to do excessive work; that, if there be heredi- 
tary disposition to gout, excessive care be taken with regard to 
diet; that any organs which may be inefficient in their func- 
tions be assisted by remedies, if possible; that above all, the 
skin be kept warm and clean by proper clothing and sponging;. 



TREATMENT OF RINGWORM. 91 

.hat the general health be improved by exercise, proper diet, 
regular hours, and remedies wnich may be called for by the 
state of the patient, such as iron, the several tonics, antacids, etc. 
Dr. Mjrrtle (Harrowgate) said, in the treatment, he thought, 
in chronic cases, the best course to adopt was to place the 
patient in the most favorable position as regards climatic sur- 
roundings, to choose an even, genial, and, if possible, a dry 
locality, where the skin and lungs might be allowed free play : 
and this of itself would prove the best remedy, the most certam 
means of retarding the progress of degeneration if it could not 
effect a cure. 



THE TREATMENT OF RINGWORM. 



Alder Smith, F. R. C. S., London, writes in the British Med- 
icai Journal on this subject, as follows : I have been trying for 
some time to find out what vehicle penetrates most deeply 
into the hair- follicles, and think it is chloroform. Chrysophanic 
acid is a very good parasiticide, and, though it is insoluble in 
spirit and ether, yet it is soluble in chloroform. Chloroform 
also dissolves the fatty matter out of the hair-follicles, and 
thus allows the parasiticide dissolved in it to penetrate deeply. 
During the last year I have used a solution of seven grains of 
the acid to the ounce of chloroform on all cases of recent ring- 
worm, and believe it is the most efficient treatment I have yet 
tried. 

The small patches should be carefully marked out by cut- 
ting the hair very closely on them, and the chloroform solution 
should be well pressed and dabbed into the places with a 
minute sponge-mop for five minutes, two or three times a day, 
according to the amount of irritation produced. The aim of 
the treatment is not to produce scab, but to get the solution to 
penetrate deeply. The sponge-mop should not be much larger 
than a big pea, and should be continually dipped into the 
chloroform-bottle, as the solution soon evaporates while it is 
pressed into the diseased spot, and leaves the yellow acid dry 
on the place. Great care must be taken that the solution does 
not run on the forehead or into the eyes, and that the person 
using it does not inhale the vapor. I always give full direc- 
tions about the care necessary in using such a potent remedy, 
and only apply it to small places of the disease. It is well for 
the nurse to keep her face away from the sponge, and to use 
the chloroform in a current of air and not in a small room. . 
The places should be well washed every morning with hot 
water and soap, to remove any sebaceous matter, or crusts, and 
the hair should be kept closely cut on them until the new hair 
appears, which is generally in about two or three months, but 
the remedy should be continued until all diseased stumps have 
come out. — American Practitioner, 



92 PULMONARY DISEASES — SCARLET FEVER. 

THE RELATION OF LARYNGEAL TO PULMONARY DISEASES. 



Dr. Bos worth's {New York Medical Journal) conclusion is, 
that the latter is seldom if ever consequent on the former. 
Almost everyone admits this with regard to syphilis, lupus 
and cancer of the larynx, yet there are many who think other- 
wise with regard to simple chronic catarrhal laryngitis, and 
tubercular laryngitis. Of these two, Dr. Bosworth thinks the 
former to be a sequel to nasal catarrh and had always found it 
incurable, until he ignored the larynx and confined treatment 
to the nose, since which time he has cured every case of chronic 
catarahal laryngitis. Since, therefore, it is but a sequel of 
chronic nasal catarrh, it cannot be said to be a factor in pul- 
monary diseases. With regard to tubercle, seventy per cent, of 
autopsies of pulmonary consumptives disclose tne larynx 
intact, whilst on the other hand no autopsy is yet recorded 
where with laryngeal tuberculosis the same condition has not 
been found in the lung. Dr. Bosworth does not believe that 
the two conditions affect each other than merely by contiguity 
of surface, but that they have some influence on each other can- 
not be disproved. 

I believe the laryngeal mucous membrane to be the most 
resistant part of the respiratory mucous membrane, and that 
with membrane intact, infection from without, such as the 
contact of foul pus, is not possible. Pulmonary tuberculosis 
is often the sequel of tubercular affections elsewhere, but very 
seldom the cause of such lesions elsewhere, even in the upper 
air passages. I think laryngeal tuberculosis alwavs an inde- 
pent centre of a tubercular outbreak.— Dr. J. C. Mulhall in the 
Saint Louis Medical and Surgical Journal. 



TREATMENT OF THE INITIAL PHENOMENA OF SCARLET 
FEVER BY THE SULPHATE OF QUININE. 



In the development of scarlet fever it is noticeable that the 
fever follows a regular course, with exacerbations which occur 
periodically. Paying attention to these intermissions and ad- 
ministering sulphate of quinine from the beginning, it was 
noticed by the author that the intensity of the fever was dimin- 
ished, and the recurrence retarded until the eruption had almost 
disappeared. Each recurrence attended or called forth renewed 
activity in the development of the eruption, the last recurrence 
being the most marked one. It is without danger, however, if 
the quinine has been given in suitable doses. In severe cases 
of the disease it is believed that quinine lessens their gravity. 
The accidents which follow scarlatina are due to a retention of 
the poisonous principle in the blood, which acts similarly to 
the poisonous principle in malarial fever. The difference in 
them consists in the rapid progress of the scarlatinal elements. 



MISCELLANEOUS ITEMS. 93 

Quinine given as a preventive is a most excellent means for 
this purpose, or for combatting them when they have already 
appeared. The author believes he is the first who has pub- 
lished a recommendation for the U3e of quinine in this disease. 
In severe cases he recommends the daily use of a gramme of 
the sulphate of quinine for two or three days, or until the exac- 
erbations have ceased. — Jour, de Med. de Paris. — Medical Ptesa. — 
Obstetric Oazette. 



MISCELLANEOUS ITEMS. 



The Brtiiah MeAioal Journal recommends chloral hydrate in 
five to ten grain doses as a specific in albuminuria with oedema 
of the lower extremities, dilated heart, etc. 

Professor DaCosta says that ergot, one-half to one drachm 
three times a day, is the best remedy for diabetes insipidus. 
When headache comes on it must be stopped and strychnine 
substituted, until this symptom passes off 

Neuralgia. — Dr. Edward Vanderpool, of New York, recom- 
mends Fowler^s solution of arsenic in neuralgia of the stomach, 
in six to ten drop doses three times per day. His experience 
with it appears to have been highly satisfactory in tne cases 
reported. — Independent Practitioner. 

Bellladonna. — Belladonna is an admirable assistant in the 
reduction of strangulated hernia. Apply the soft extract freely 
to the structured neck after softening the surface with warm 
water, exercise a little patience, and then grasping the sack 
with both hands, gently compress it, drawing it away from the 
neck, swaying it from side to side; and in nineteen cases out 
of twenty of recent strangulation, the bowels will be speedily 
returned — especially if you elevate the hips and relax the 
abdominal walls. 



High Potency Homceopathy. — Dr. H. M. Paine, of Albany, 
expresses himself thus clear and forcibly: "Dynamic (high 
potency) practice is an outrage on well known philosophical 
principles, an insult to common sense, and an offense to com- 
mon honesty. The result of scientific research shows that 
chemistry is unable to furnish proof of the material presence 
of a drug beyond the third potency ; the spectroscope none 
beyond the seventh ; and the theory of molecular magnitude 
(mathematical demonstration) none beyond the eleventh. — 
Medical Annals. 



Corrosive Sqblim ate in Urethritis. — M. Chameron ( Union 
Medicale) has recently presented a thesis upon this subject, in 



94 MISCELLANEOUS ITEMS. 

which he advocates the injection of a solution of corrosive sub- 
limate (one to twenty thousand) in chronic urethritis on the 
ground that the gonococcus or specific parasite of gonorrhoea is 
destroyed by a solution of this strength. Three iiyections of 
the warn) liquid are to be given daily, after the act oi urination. 
Care should be taken that it reaches the deepest part of the 
canal. The writer mentions several cases which were cured in 
a week under this treatment. 



Ointment of Vaseline and Nitrate of Silver in Strumous- 
Glands. — Professor Ferraris claims that by inunction of stru- 
mous glands with an ointment made of ten drachms of vase- 
line and one of nitrate of silver, that the inflammation is con- 
fined to the gland proper, and thus fistulse and ugly scars are 
prevented ; that pain is always relieved, and that frequently 
complete resolution takes place. I have never tried the plan, 
but can recommend as one of the best, an ointment of one or 
two drachms of iodoform to an ounce of lard. Many strumous 

f lands, however, resist all kinds of treatment. — Dr. J. C. Mul- 
all in Saint Louis Medical apd Surgical Journal, 

Help for Red Noses. — When alcohol or the force of circum- 
stances, has brought to a man a red nose, it has generally been 
considered irremediable. He tries, perhaps, a few bran poul- 
tices, and then abandons himself to the inevitable rubescence. 
Mr. Macolm Morris reports (British Medical Journal) considera- 
ble success with acute rosacea, when thus affecting the nose, 
through the use of linear scarifications. He has tried this 
method in the way recommended by Mr. Squire as a remedy 
for port-wine mark but failed of doing any good. Applying it 
to other conditions, however, he had much better success. His 
plan is to scarify the afiected parts in paralleled lines, allowing 
some blood to flow. He repeats the operation from ten to 
twelve times. — Medical Record. 



Chloroform and Croton Oil for Tape-Worm. — Dr. Bern- 
ard Persh, according to the Medical and Surgical Reporter, has 
most satisfactory results in cases of tape-worm with chloroform 
and croton oil. He suspends one drop of croton oil and a 
drachm of chloroform in one ounce of glycerine, this to consti- 
tute one dose. The medicine is best given in the morning 
before breakfast, and no preparatory treatment is required, 
except half an ounce of Rochelle salt on the evening preceding 
the removal. The preliminary laxative is not necessary to 
efiect a cure, and it was omitted in several cases; but its admin- 
istration facilitated the examination of the evacuations, pre- 
vents breaking up the worm by hard froces, and allows the 
parasite to pass more quickly through the intestine after be- 
coming detached. The medicine is not unpleasant to take and 



MISCELLANEOUS ITEMS. 95 

acts quickly. If any intestinal irritation is caused it may be 
•controlled with bismuth and opium after the expulsion oi the 
worm. — Weekly Medical Review. 

Concerning the new laxative and purgative, '* Prangulax- 
ine," Dr. C. Henri Leonard, of Detroit, says: "I have used it 
very largely in the class of cases that I have to treat, females, 
as in them constipation is a common symptom needing correc- 
tion. I have found nothing to equal it as a laxative for them. 
It secures a free, easy, bilious stool each day by taking a des- 
sertspoonful before the morning meal. It is perfectly palatable 
and works without griping, so far as my experience goes with 
the mixture. Sometimes, if the constipation is obstinate, I 
have found that a second dose, before the noon meal, was nec- 
-essary to secure for the first few days a free evacuation. At 
my clinics at the dispensary of the Michigan College of Medi- 
cine I frequently prescribe it, combined with the other medi- 
cines used in gynsecological cases, as notably the bromides, 

thus: 

R. Potassii bromidi (grams 15).. Jss. 

Ergotse, fl. ext. (grams 15) %m» 

Elixir frangulaxiiie (grams 60}....... ^ii. 

Tr. cinchonse comp. (grams 60) 3"- 

M. Sig. Teaspoonful in water after each meal. 

If a stronger laxative efiect is desired, then I put in more 

of the elixir frangulaxine, and less of the tonic, the tincture 

<;inchonse compound. If I wish decidely to impress the chylo- 

poietic system, then I make use of the frangulaxine in the 

powder form, as: 

B. Frangulaxine pulvis (grams 15)...... ^ss. 

Calomelis (grams 2) grxxx. 

M. Div. in chart, number 15. Sig. One before breakfast and 
dinner, for three days; then stop three days; then begin again. 

In my own family I have found the elixir frangulaxine to 
be most an excellent laxative for infants and children, the dose 
varying from one-fourth to a teaspoonful according to the age 
of the child, giving it before the morning and noon meal. 

Diabetes Mellitus — Rheumatism. — Case I. — Mrs. H., aged 
fiixty-two, native of Kentucky, troubled with attacks of diabetes 
at irregular periods for the past ten years, of late years suffering 
a great deal with severe cystorrheuraa ; pain in the back and 
loins; incontinence of urine. The usual remedies have been 
persistently tried without any permanent benefit; to palliate 
the suffering, and for the time being to partially control the 
vexatious dribbling was the best I could do, until lithiated 
hydrangea (Lambert) was brought to my notice. At iSrst I 
ordered a teaspoonful of this compound every six hours, then 
every five hours and finally every four hours, continuing this 
treatment for nearly six weeks. Good results commenced from 



96 MI8CELIJINE0US ITEMS. 

the first; one by one the complications gave way until finally 
the whole train of evils were overcome. The patient to-day is 
comparatively free from the disease that has been the vexation 
of her life for so long a time. Whether or not this relief may 
prove a permanent cure in so old a patient, it indicates the 
extraordinary merit of the lithiated hydrangea in a case in 
which other current remedies had failed, and I should state that 
none other were used in conjunction or alternated with it. 
Case //.— Myself the subject. Rheumatism, nephritic origin. 
Lithiated hydrangea gives me relief in from twenty-four to 
thirty-six hours, taken in drachm doses every three or four 
hours, not only being quicker and more effectual than other 
remedies, but mr more palatable and agreeable to the stomach, 
never causing any disagreeable symptoms. — S. E. Hardin, M. 
D., of McFall, Missouri, in Saint Joseph Medical Herald, 

The attention of the medical profession has of late been 
closely directed to the cause of trie enormous proportion of 
infantile (deaths, as recorded in the mortuary records. The 
general conclusion seems to be that this terrible loss of life in 
young children, especiall}' at the critical period during the ear- 
lier months of dentition (at which time some artificial food is 
generally either added to, or entirely substituted for, the natural 
aliment), is largely due to innutrition; in other words, that 
owing to the want of an artificial food calculated to supply the 
great demands upon the system, the infant is, in effect, starved 
Although, perhaps, diluted cow's milk offers the best substitute 
for that designed by nature, yet in so few cases can this be 
found pure, at least in cities, that it does not contain the essen- 
tial ingredients for the support and development of infantile 
life. Estimated in a cursory manner, human milk contains 
about eight hundred and ninety parts of water to one hundred 
and ten parts solid matter; and of this solid matter caseine, fat, 
and saccharine matter occupy the larger proportion. If milk 
contains these ingredients in the proper proportion, it is assimi- 
lated by the infant, and we have as a result healthy growth and 
development; but if these constituents are wanting, the child is 
imperfectly nourished, and easily falls a victim to the many 
disturbances which accompany dentition. To meet this want 
sevenil artificial milk foods, more or less scientifically prepared, 
have been introduced to the public, and one of the most desir- 
able is that known as the Anglo-Swiss milk food (made by the 
Anglo-Swiss Condensed Milk Company at Cham, Switzerland). 
This food has been proved to contain all the necessary ingre- 
dients for a reliable food for infants, and having received the 
highest endorsements from the medical profession in Europe, 
and in New York and other large American cities, may, there- 
fore, be used with perfect confidence by all having the care of 
young children. 



THE 



PHYSICIAN AND SURGEON 

A MONTHLY MAGAZINE, 
DEVOTED TO MEDICAL AND SURGICAL SCIENCE. 



Volume VII. MARCH, 1885. Number III. 



ORIGINAL AETICLES. 



A CASE OF ACUTE TUBAL NEPHRITIS COMPLICATED WITH 

PNEUMONIA: RECOVERY. 



BY W. T. DODGE. M. D., Marlstte, Michigan/ 



On May 6, 1884, 1 was called to see J. W., age^sixty-two ;. 
occupation, veterinary surgeon ; a man of robust constitution 
who had never before been under a physician's care for any 
diseased condition. He has been of very intemperate habits,, 
especially since he was forty years of age, until two years ago- 
when he discontinued the use of liquor entirely. He was con- 
nected, in his professional capacity, with one of the lumbering 
firms of Northern Michigan, and attended to his duties until 
about the first of April, when he left the camp and entered. 
upon a prolonged spree. 

About April 15, he stopped at a hotel in Clare, Michigan » 
and was awakened sometime in the night by a draught ol air 
passing over him. He found the window hoisted near his bed 
and himself thoroughly chilled. A cough commenced soon 
after this; a week later oedema of the feet and legs occurred 
and he noticed his urine to be scanty and high colored. He is 
certain he had a fever all this time, but attended to his duties, 
and consulted a physician at Mount Pleasant who treated him 
two weeks without benefit and then told him he had Bright's 
disease and would die, and advised him to seek his friends and 
close up his business. 

Acting on this advice, he came here, where he has relatives, 



S8 . ACUTE TUBAL NEPHRITIB. 

and on May 6, 1 was called to see him. I found him sitting in 
a chair, .breathing with some difficulty, and with a distressed, 
anxious expression ; but perfectly clear in his mind and able 
to give a aefinite account of his illness. There was general 
<Bdema, more marked in the feet and legs which were enor- 
mously distended and cold nearly to the body. His vision was 
much impaired. On physical examination, I found abundant 
mucous rales and eviaences of pleural and pericardial effusion. 
The quantity of urine for the twenty four hours was four ounces. 
It was dark colored and possessed an abundant deposit of 
urates, renal epithelium, granular and epithelial casts. On 
the application of heat and nitric acid the urine in the test tube 
became semi-solid. I had little hope of a favorable result in 
the case but determined to give him the benefit of treatment, 
and prescribed one ounce of the infusion of digitalis twice a 
day, barley water as a beverage and four grains of ammonia 
muriate every two hours. I instructed him to eat mainly 
liquid food and to take a warm bath. The next morning at 1 
o'clock I was called to see him and found him occupying a 
semi-prone position, the dyspnoea much increased and 3ie 
heart sounds very feeble. I gave him two drops of oil of tiglii. 
In two hours this produced a free watery passage, and during 
the following twenty-four hours he had eight or ten tree watery 
evacuations. The digitalis was continued and I was gratified 
to find a marked improvement in all his sprmptoms. The 
breathing became easier, the swelling of the feet decreased, a 
free perspiration set in, and his vision was much improved. 
He passed thirty-two ounces of urine in the twenty-four hours. 
Its specific gravity was 1020, and it contained a large deposit 
of urates and epithelium. The quantity of albumen was slight. 
His condition continued to improve until May 11, when he 
complained of a pain in his right side. On examination I 
discovered crepitant and sub-crepitant rales over the lower por- 
tion of ^the right lung; temperature, normal; pulse, 100, and 
feeble. He passed large quantities of urine and it contained no 
trace of albumen. I prescribed two grains of muriate of ammo- 
nia to be ffiven every three hours. His mind, which up to this 
time had been clear, now became deranged. At times he talked 
rationally but the greater portion of the time suffered from a 
low muttering delirium. His oedema gradually disappeared 
and after May 14, none was observable. He became very an»- 
^mic and raised considerable thick, tenacious sputa. Careful 
•observation with the thermometer, twice a day, failed to dis- 
cover a raise in temperature, The pulse continued feeble and 
rapid. The dose of digitalis was gradually reduced and finally 
discontinued. He was given twenty grains of jpotassi bromiai 
•«very four hours to procure sleep and (juiet delirium; and I 
also prescribed potassi acetatis with fern acetatis as a diuretic 
and tonic, and applied a fiy blister to the right chest His 



TREATMENT OF PITYRIASIS RUBRA. 99 

condition continued very much the same for two weeks, and 
with the addition of an occasional dose of magnesium sulphate 
the above treatment was continued during that time. The 
thermometer did not at any time show an elevated temperature, 
but in other respects the pneumonia followed its usual course. 
The symptoms gradually ameliorated, the delirium gradually 
disappeared, and in the course of three weeks he was able to 
walk out of doors. 

On August 1, 1884, 1 obtained a specimen of his urine and 
examined it with the following result: quantity for twenty-four 
hours, thirty ounces; specific gravity, 1025; reaction, acid; no 
deposit; no albumen. At this writing, January 1, 1885,. he is 
in perfect health. 

SALICYLIC ACID IN THE TREATMENT OP PITYRIASIS RUBRA. 



BY F. E. WOOLSEY, M. D., Bsllaibs, liicHXOAN. 



In November last Mr. 0., aged thirty-five, came to my 
office, suffering, as he expressed it, ^' untold misery," with most 
intense itching. This symptom was accompanied with inflam- 
mation and scaliness of the skin. The inflammation began in 
small patches quite superficially, which had gradually spread 
over his person until nearly the entire surface of his body, 
except his hands and face, were involved. This redness was 
not attended with any particular swelling of the deeper fascia. 
The scales were very thin, dry and white; they^were variable 
in size, and were more or less evenly incrusted. * These scales 
were detached by the least scratching and rubbing and fell in 
profuse quantities on rolling up the shirt sleeves or drawers. 
When a spot was denuded by scratching the reddened condition 
could then be seen. 

It had been first noticed about three weeks previous. In a 
few days the cuticle began to scale off as above described. It 
was constantly growing worse. The diseased surface was dry 
and harsh to the touch, and when the scales were forcibly 
removed, it produced considerable pain, leaving the skin red 
and moist, to be again covered in a few hours. The intense 
itching and tingling would cause a constant desire to tear the 
parts with the nails, and when this was done a serum exudate 
would soon form. 

He had been constantly growing worse during the several 
weeks of the disease, under the treatment of an old practitioner 
of electicism, and had become very anxious to have relief, and 
came to me with the question, ^'Can you cure me?" an inquiry 
that is often asked a physician, and not wise always to 
answer either affirmatively or negatively. In this case a direct 
answer was avoided and he was informed that I would assume 
te treat the case, leaving time te determine the result. 



100 ASIATIC LEPROSY. 

He was given liquor potaspse arsenitis, and the parts rubbed 
with an ammoniated mercury ointment. This treatment was 
continued for one week without any improvement. Salicylic 
acid was then added to the ointment and the patient directed 
to apply it thoroughly tWice a day, and ordered a bath to be 
taken ever ni^ht, with as much aqua ammonia in the water as 
could be easily borne. The following was substituted for the 
solution of arsenic: 

B. Potassii iodidi ^ss. 

Stillingia ext., fl., 388. 

Sarsaparilla ext, fl., ^vi. 

Syrup simplex, ad. q. b., dvi. 

M. S. A teaspoonful to be taken every four hours. 

Under this treatment the disease gradually yielded and 
after a period of four weeks he was discharged cured. 

The only complication met with was some oedema of the 
legs below the kneed, but this caused no uneasiness as his heart 
and kidneys gave no evidence of disease. I attribute the 
result of the treatment to the salicylic acid, as improvement 
began soon after the change in the treatment. 



GENERAL CORRESPONDENCE. 



ASIATIC LEPROSY. 



Editor OF The Physician and Surqeun: We have of late 
had a large number of cases of leprosy to treat at the Syrian 
Protestant Hospital in the city of Beirut As it is a disease 
seldom met with in the United States, I thought a brief men- 
tion only of its leading characteristics might interest some of 
your readers. 

There are two varieties of leprosy recognized in this country : 
(1) The tuberculous; and (2) The non-tuberculous. The first 
is by far the most frequent. It is characterized by the presence 
of tubercles; while the less common form is characterized by 
bullse. Both varieties are often blended producing a mixed 
form; when distinct they have many symptoms in common, 
and their duration and termination are essentially alike. Most 
of the cases seen at the hospital have been of the tubercular 
variety. It is this type of the disease which prevails in the 
East Indies, China, Africa and the East generally, and the one 
I refer to in this brief description. It is a sporadic^ chronic, 
specific, organic, constitutional disease, attended with local 
manifestations. It is probably a filth disease — certainly a 
filthy one. This alone would seem sufficient, but it is unques- 
tionably hereditary and considered by the people very con- 
tagious — doubtfully so by the medical profession of the East. 
The people's opinion, however, seems to be supported by the 



ASIATIC LEPROSY. 101 

fact that turkeys, pigeons and mice which have fed about the 
premises of lepers have presented symptoms which correspond 
very closely if not exactly with leprosy in man. It is much 
more frequent in males than females and the common period 
of attack is between the ages of twenty to thirty, seldom before 
five or after forty years. It is said to have been congenital in 
a few cjises. The great predisposing caiise is undoubtedly hered- 
ity, and it is much more likely to be of maternal than paternal 
transmission. The exciting causes are believed to be poor living, 
want of cleanliness, and exposure to cold and damp. These at 
least are constant attendants of the disease. A diet of fish, 
«alted meat, or oil, if not exciting causes always aggravate the 
•disease. 

Symptoms, — One of the earliest is anaesthesia or a tickling or 
pricking sensation (formication) of the extremities or face, 
but these sensations are seldom felt over the trunk. Soon the 
hair of the head, the eyebrows and cilia begin to gradually fall 
out and so Continue until they disappear entirely; the beard 
falls to a less extent. The skin, especially of the face, forearms, 
hands, legs and feet become at first puffy, and later it changes 
to a dark red color aiid becomes thickened by the deposit of 
tubercles in its deeper layer, producing hard nodular elevations 
seldom smaller than a pea and of a reddish color. The skin at 
this time is quite shining in appearance. These tuberculous 
deposits also occur in the mucous membrane, especially of the 
iia.sal passages, pharynx and larynx, thickening it and partially 
■closing these cavities, producing diflBculty in breathing and a 
peculiar husky nasal quality of voice, the force of which is often 
diminished to a whisper, or entirely lost. Later on, there is 
ulceration in and about the deposits which gives rise to a fetid 
and purulent discharge. In this way the epiglottis and trian- 
gular cartilage of the nose are destroyed. The joints of the 
fingers and toes are similarly affected ; and the distal and sec- 
•ond phalanges are often destroyed. Ulcers which have healed 
leave large cicatrices. There is always general malaise, febrile 
flushes, a peculiar heaviness affecting the whole body, and 
•depression of spirits. While the above changes are going on 
the general health is more or less impaired, and after a few 
years, averaging usually from nine to twelve, the patient sinjcs 
from exhaustion, or some intercurrent disease — as inflammation 
•of air passages, anasarca, diarrhf^a or dysentery. The symp- 
toms of leprosy and the appearance of the patient are so strik- 
ing that a person will always recognize the disease after once 
having seen a case. 

The description of Jewish leprosy given in the twelfth 
chapter of Leviticus shows that it was nothing very definite. Any 
"bnght spot" in the skin, if it be white or **scab," if it spread, 
was leprosy. "If a bright spot be deeper than the skin and the 
hair turned white," it was leprosy. In the case of a swelling 



102 HEALTH IN MICHIGAN. 

or " rising if it be white in the skin, and it have turned the hair 
white, and there he quick raw flesh in the rising" it was- 
leprosy. The further details in this description of Jewish 
leprosy show that it was an entirely different disease from 
modern leprosy. A. F. Dight, M. D. 

Beibut, Syria, January 5, 1885. 



HEALTH IN MICHIGAN DURING JANUARY, 1886. 



Reports to the State Board of Health, Lansing, by observers 
in different parts of the State, show the diseases which caused 
^most sickness in Michigan during the month of January (four 
weeks ending January 31), 1886, as follows: 

Disedaea arraTiged in order of greatest pr«i?atenc«.— Neuralgia; 
rheumatism; bronchitis; tonsilitis; consumption of lungs; 
influenza; intermittent fever; pneumonia; erysipelas; remit- 
tent fever; diarrhoea; inflammationof kidney; whooping-cough; 
diphtheria; inflammation of bowels; scarlet fever; membran- 
ous croup; typho-malarial fever; typhoid fever (enteric); cere- 
bro-spinal meningitis; inflammation of the brain; dysentery ;^ 
cholera morbus; measles; puerperal fever; cholera infantum. 

For the month of January, 1885, compared with the preced- 
ing month, the reports indicate that pneumonia, erysipelas, 
neuralgia, tonsilitis, influenza, and consumption of the lungs 
increased, and that diarrhoea, typho-malarial fever and remit- 
tent fever decreased in prevalence. 

Compared with the average for the month of January in 
the seven years, 1879 to 1885, neuralgia and erysipelas were 
more prevalent, and pneumonia, diphtheria, intermittent fever, 
measles, dysentery, remittent fever, and scarlet fever were less- 
prevalent in the month of January, 1885. 

For the month of January, 1885, compared with the aver- 
age of corsesponding months for the seven years, 1879 to 1885, 
the temperature was lower, the absolute humidity and the day 
and night ozone were less, and the relative humidity was more. 

Including reports by regular observers and others, diph- 
theria was reported in Michigan in the month of January, 1885^ 
at forty-two places, namely, — Attica, Boardman, Bloominsdale, 
Charlevoix, Chocolay township, Dansville, Detroit, Delhi, 
Delhi township, East Saginaw, Gaines, Gaines township. Grand 
Rapids, Genoa, Harrisville, Handy, Hancock, Hastings, Hud- 
son, Ingham township, Imlay, Ishpeming, Kalamazoo, Lyons, 
Negaunee, Novi, Novi township, Orleans, Oscoda, Oslitemo 
township, Owosso, Pierson township, Plymouth, Port Crescent, 
Quincy, South Boardman, Sand jBeach, Thornville, Taylor 
township, Watervleit, White Oak, and Wyandotte; scarlet 
fever at thirty-seven places, — ^Albion, Algonac, Bellaire, Belvi* 
dere township. Clam Lake township, Charlevoix, Detroit, East 
S^inaw, Fawn River, Grand Rapids, Genesee, Highland^. 



TREATMENT Ot^ PUERPERAL ECLAMPSIA. 103 

Homer, Ida, Kalamazoo, Leland township, Lowell, Manistee^ 
^Muskegon, Negaunee, North Muskegon, North Lansing, Pon- 
tiac, Pierson, Pierson township, Quincy, Sault Saint Marie^ 
Saint Louis, South ITaven, Sears, Sheridan, Thornville, Water- 
vleit, Wheatfield, Whitehall and Westphalia; measles at four 
places, — Detroit, East Saginaw, Grand Rapids and Hopkins 
township; and small pox at South Boardman. 

Henry B. Baker, Secretary. 

Laioimo, February 6, 1885. 



ORIGINAL TRANSLATIONS. 



FRENCH LI7ERATURE 
Trucblated by E. J. WHITEHEAD, A. B.. Ann Arbor, Michioan. 



THE TREATMENT OF PUERPERAL ECLAMPSIA. 



Thoae physicians who considered that eclampsia was due 
to plethora proposed phlebotomy 21s the easiest and most 
rapid method of depletion : those who thought that cerebro- 
spinal excitation was the cause of the disease favored anaes- 
thetics and anti-spasmodics, such as chloral, chloroform, bro- 
mide of potassium, and opium. Another theory was that 
eclampsia was caused by uraemia during pregnancy. Those 
who held this belief advised the use of diuretics, drastic pur- 
gatives, sudorifics, milk, pilocarpin,— trying thus to remove the 
poison by the action of the kidneys, the ihtentines and the skin» 
At present, since the relation between nephritis and eclampsia 
has been established, all are agreed that the proper plan is to 
prevent the attack by treatment of the renal disease. 

Preventive treatment for eclampsia is the same as that for 
prevention of albuminary nephritis. For this the patient 
should be put upon a milk diet, which should be continued as 
long as there is albumen in the urine. The return to ordinary 
diet should be gradual. Bitters, tonics, alkalies, and iron will 
be found very useful. Under the influence of milk the urine 
becomes clear and abundant, tha oedema disappears as also do 
the vertigo and headache. As adjuvants to the diuretics one 
may employ evacuants, such as the sulphates of sodium and of 
magnesium, together with vapor baths. However, it should 
always be borne in mind the kidneys form the true filter for 
the separation of urea, and that the amount of urea excreted 
through the skin and the intestines is trifling in comparison 
with the amount contained in the urine. 

Cazeaux, Peter, and Depaul are the great champions of 
bleeding. Peter claims that a pregnant woman does not 
become plethoric because her blood is rich in red corpuscles : 
on the contrary, the amount of serum in blood is increased 



104 TREATMENT OF PUERPERAL ECLAMPSIA. 

and there is a predisposition to conjestion of all the organs, 
particularly of the kidneys, the circulation in those organs 
being so intimately connected with the uterine functions. In 
M. Peter's opinion this renal conjestion is the cause of albumi- 
nuria, and everything that tends to remove the conjestion (such 
as wet cupping over the lumbar region, bleeding, and purga- 
tives) will diminish the albuminuria and, therefore, the pre- 
disposition to attacks of eclampsia. 

If, during labor, there are premonitory symptoms of con- 
vulsions, an attempt should be made to prevent the attack by 
bleeding; but if there be not sufficient time for that, chlor«d 
and chloroform should be used. Another method of preven- 
tion consists in the rapid termination of labor, provided the 
dilatation or dilatabilitv of the cervix will allow it. 

During an attack anti-spasmodics and sedatives are useless 
because of the slowness of their action. Chloroform must be 
given freely. It is sometimes necessary to keep the patient 
under it^ influence for ten to fifteen hours. On account of the 
danger attending the inhalation of toxic vapors while the 
respiration is so greatly deranged as it is during the convul- 
sions, it is of the greatest importance to keep the apartment 
thoroughly ventilated. 

The amount of chloroform necessary to maintain aneesthesia 
may i)e lessened by the simultaneous use of injections of chloral 
hydrate, four to six grammes at a tiiAe. A fall in the tempera- 
ture of the patient indicates that the remedies are acting favor- 
ably, if the temperature remains constant, or if it rises, more 
chloral and chloroform must be given. Charpentier has given 
from twelve to sixteen grammes of chloral during twenty-four 
hours. The bladder should be emptied, something should be 
put between the patient's jaws to prevent her biting her tongue, 
and she must be kept as quiet as possible. 

During the period of coma, if the face is turgid and there is 
threatened conjestion, several leeches should be applied to the 
mastoid processes, especially if bleeding be considered inju- 
rious. Active depletion by means of calomel or ialap may be 
tried. The general opinion is that it is best, both for the 
mother and for the child, that labor should terminate as soon 
as possible, but there is great diversity of opinion as to whether 
the process should be artificially induced. In cases where the 
mother's life is greatly endangered, Tarnier and Bailly rec- 
ommend the causing of premature labor by the dilator, uterine 
sound, or douches of warm water to the cervix every twenty 
minutes. However, such violent measures are not generally 
regarded with favor, being too dangerous both lor the mother 
and for the child. 

If the convulsions continue after delivery, the physician 
should, as soon as possible, remove from the uterus tne clots of 
blood contained in it. The severe haemorrhage that sometimes 



>^ERVR CENTRES OP THE UTERUS. 105 

follows is to .be opposed by the usual means — injections of hot 
water, the hand in the uterus, spurred rye, or injection of 
ergotine. 

We may sum up the matter as follows: during an atti^ck, 
keep the patient from violently exerting herself, prevent her 
falling, or biting her tongue. Keep the room well ventilated. 
To prevent another attack, we would advise the inhalation of 
<;hloroform and the injection of four to six grammes of chloral 
in a glass of milk. Ifj at the end of two to four hours, the tem- 
perature does not fall, the injection of chlornl should be 
repeated. Not more than sixteen grammes should be used 
during twenty-four hours. If the woman is plethoric, the 
countenance indicating conjestion, with deep coma, three hun- 
dred and fifty to four hundred and fifty grammes of blood 
should be drawn, to be repeated if necessary; if the woman is 
feeble, leeches should be applied to the mastoid processes; a 
brisk purgative is also useful. On the other hand, mustard- 
plasters on the legs have sometimes seemed to cause an attack 
on account of their irritation. If the patient is at term or if 
abortion occurs and labor is progressing regulary, the physician 
should not interfere until the cervix is dilatable or dilated, and 
should then hasten delivery as much as possible, either by ver- 
sion or by the forceps. 

Various other remedies than those above mentioned have 
been recommended, bu. they are either too slow or too danger- 
ous in their action. According to Barker, injections of pilocar- 
pine have caused bad results. Intra-venous injection of chloral 
18 often dangerous, its subcutaneous use often causes phlegmons. 
Bromide of potassium is uncertain. Opium, in some form or 
other, is always useful, but must be given in large doses. — Con- 
cours Medical. 

THE NERVE CENTRES OF THE UTERUS. 



According to the researches of Demke, of Paris, the ganglia 
found in the interior wall of the vagina are the centres for the 
•contraction of the uterus. The writer thinks he finds confirma- 
tion of this in the following case observed by him : 

The patient had suffered for some time with metritis and 
perimetritis. The uterus, increased in size, was very sensitive, 
covered by exudata [exudats-resten] flexed strongly towards 
the right, but movable. The patient had been for a long time 
•confined to her bed. She had been advised to use injections of 
warm water. This had caused her such severe pain that she 
had determined to give up their use. When the patient allowed 
the physician to make the injections no pain was experienced. 
The conjecture that the patient had not introduced the uterine 
tube properly, and had pressed the point against the anterior 
vaginal wall was thus confirmed. For as soon as the writer 



106 ' HYGROMIC CYST OF THB NECK. 4 

touched the anterior wall with the instrument, painful contrac- 
tions of the uterus were caused, during which the rigidity of the 
uterus could be easily determined. 

The writer believes that by the chronic inflammation in the 
pelvis, and the hypersesthesia connected with it, the excitability 
of the ganglia in question was increased. 

In cases of women jiot pregnant, or who had diseases of no 
great severity, there were no contractions consequent upon irri- 
tation of the vaginal ganglia. The writer is further of the 
opinion that the effect of vaginal tampons was due to the irri- 
tation of the nerve-centres of the uterus. — Dr. Kurzin Schmidf^ 
JahrbUcher, 



GERMAN LITERATURE, 

TBAM8LATED BY J. A. BOBB. ANN ARBOR. MICHIGAN. 



A CASE OF HYGROMIC CYST OF THE NECK: REMOVAL BY 

OPERATION. 



BY DR. PLATH, Siettin. 



On account of the comparative rarity of this form of cysts, 
and a cure of the affection very seldom, it seemed to me Veil 
worth while to publish the following case. The informatioa 
seems to me to be of still greater worth, when it is understood 
that this mode of treatment, when not interrupted by any 
unusual accident, encourages prompt recovery by a radical 
removal of the tumors; also, that a perfectly dry healing wound 
is obtained by covering ii with iodoform gauze after the opera- 
tion, and thereby prevent the dreaded exhaustion of the patient, 
caused by a sequence of suppuration in the connective tissue. 

The child in the case under consideration was born at Grei- 
fenhagen on the 3d of September, 1883. Soon after birth a 
flat tumor was observed close under the chin, which extended 
along the entire lower jaw. The skin covering it was normals 
The thickness of the tumor was about an inch and a half. 

A physician who was immeiiiatelv consulted, diagnosed the 
cystic nature of the tumor, and six days after birth, punctured 
it at three different places. A clear urine-colored fluid escaped,^ 
and the skin collapsed. The next day the tumor was again 
filled with the fluid. There were two similar operations upon 
it at intervals of six days each. The tumor was punctured at 
three different places each time. After the last operation it did 
not only fill to its original size, but it began to grow rapidily, so 
that the parents determined to bring the child to the hospital,, 
and at all events try a radical cure. 

On the 28th of September the child was for the first time 
placed in the '* Institute for the Treatment of Children," at tlii» 
place, and the status prsssens on that day was as follows: 



HYOROMIG CYST OF THE NECK. 107 

For its age the child was well developed and well nour- 
ished; somewhat pale; it looked about cheerfully; breathed 
easily; nursed, swallowed and digested well; and had a healthy 
cry. " Close under the chin a tumor, coverea with normal skin, 
was observed ; it extended along the lower border of the inferior 
maxilla, and as far down as the manubrium sterni; it had the 
appearance of a bag, and covered the whole anterior part of the 
neck. This tumor was not tense, but fluctuated distinctly. In 
the median line a shallow furrow, and during palpation, a par- 
tition wall could be seen, which divided the cyst into a larger 
right and smaller left; portion. At the lower border of the 
tumor, on the left side, three hard lumps, each the size of a 
cherry, were found just beneath the skin. No abnormalities 
could be seen by looking into the mouth. Aside from this 
tumor the child appeared perfectiy normal. 

As the child was nursed by the mother it could not be left 
in the hospital, but the parents promised to return with it the 
next day, which they did. On tnat day, the 23d of September^ 
after carefully investigating* the field of operation, I made two 

Sunctures into each portion of the tumor with a trocar and 
rew off about three hundred grams of light urine-colored fluids 
somewhat similar to hydrocele fluid. The fluid contained a 
large amount of albumen; and after standing for four or five 
minutes it became a jelly-like mass. After the puncture, the 
skin collapsed on both sides, except in the middle close under 
the chin, a small pliant lump the size of a cherry yet remained. 
This, on examination, proved to be a third division of the cyst 
This newly-discovered cyst, I did not puncture this time as I 
wished, first to see what effect the operation thus far made 
would have upon the child when reaction set in. 

The next day the tumor was as large as ever ; three days 
later it increased in extension and in tensity, and tlie skin 
became inflamed. The inflammation was chiefly on the right 
side. The tumor felt hot to the touch ; the child was restless, 
it nursed, but considerably less than usual. There was no diffi- 
culty in breathing and swallowing. As the child's strength 
rapidly diminished and life itself became a question, six days 
after the last operation I made a broad incision on each side of 
the tumor. Laudable pus came out of the right cavity ; out of 
the left, besides a wine-colored fluid, a coagulated mass the Kize 
of a hen's egg, of reddish-brown color, which after discharging 
a serum-like fluid suddenly collaped. After it collapsed, it 
changed color, becoming light yellow, and displayed a fibrous 
texture. Unfortunately it was lost without further examina- 
tion. A finger introduced into the cavity found the walls to be 
smooth. I now made an incision from the middle wall of the 
left cavity into the above mentioned third cyst. After washing 
out the cavities with a two per cent solution of carbolic aoid, 
I filled them with iodoform gauze, laid iodoform gauze over the 



108 -DISLOCATION OF SHOULDER. 

incision, and tied down the dressing with a woolen bandage, 
carrying it around the neck, head and breast. The child bore 
the operation exceedingly well ; it did not become feverish in 
the least, and it soon regained its normal appetite. Two days 
afterwards, when the dressing was changed the wounds showed 
no reaction. The inflammation of the skin had dissappeared. 
About a teaspoonful of cystic fluid .was taken out of the left 
cavity, after removing the gauze. On the two following days a 
very small amount of this fluid was taken out of the same 
cavity, but after the fifth day it disappeared. The cavity grad- 
ually closed up, and by November 27, 1883, the wounds were 
completely healed. At this time the child looked very well; 
had a good appetite; the hcars were scarcely perceptible. On 
the left side the three hard lumps previously mentioned, one 
the size of a cherry pit, another the size of a plumb pit, and the 
third half the size of a walnut, remained. But it is hoped that 
these in the course of time will also disappear. 

The treatment of this case shows how useless the punctures 
were, how dangerous their effects, notwithstanding all possible 
precautions; and on the. other hand what successful results 
were obtained by the d^ep incisions. 



HOSPITAL REPORTS. 



MICHIGAN STATE HOSPITAL. 



SURGICAL CLINIC, 

UNDER DONALD MACLEA-N, M. D., 

Professor of Surgery and Clinical Surgery in the University of Michigan. 

JOHN WM. BOSMAN, A. B., CLINICAL Clerk. 



DISLOCATION OF SHOULDER, FOLLOWED BY ABSCESS AND 
NECROSIS: EXCISION: RAPID RETURN OF USE.. 



Reported by O. C. STRICKLER, Class of 1885. 



Albert Randall, aged twenty-two, Bangor, Michigan; occu- 
pation, a sailor. On the 15th of May, 1883, patient' fell into 
the hold of a vessel, causing dislocation of shoulder-joint. 

Patient was admitted to Albany City Hospital, where he 
was under the care of several physicians. At that time an 
abscess had formed anterior to the glenoid cavity, which was 
opened by the attending physician, and pus evacuated, but no 
bone was found in the discharge. Patient says that the physi- 
cians then advised amputation, to which he would not consent. 

December 17, 1884: Patient was shown before the class, and 
on examination a sinus connected with the glenoid cavity was 
found discharging sanious pus. Patient has lost control of 



RAILROAD INJURY. 109 

arm, bi^t has good movement in forearm. Dr. Maclean advised 
the operation of excision of the head of the humerus. 

December 23: On incision the head of the humerus was 
found necrosed and imbedded in a mass of inflammatory new 
formation. An examination disclosed a deep cup-shaped 
cavity in the head of the humerus', from the posterior portion 
of which a projection not unlike the Acromion process of the 
scapula was round . This projection was mistaken for the 
Acromion until the fingers were passed behind it into the 
glenoid cavity. The head including one and one-half inches of 
humerus was then removed with the chain saw. A counter 
opening was made at the posterior portion of glenoid cavity to 
allow perfect drainage, into which a tent was introduced- The 
usual dressings of oiled silk and cotton were then applied and 
firmly bandaged. 

December 24 : Cavity washed out with carbolic acid solution 
and wound dressed. 

December 25 : As bowels had not moved since operation an 
enema was given which produced a slight passage. 

December 28: Patient passed a restless night.* 

December 29: A dose of castor oil was given to produce a 
movement of bowels. 

December 31: Patient feels well ; temperature, normal. 

January 19, 1885: Dr. Maclean advised passive motion after 
each dressing, and arm to be carried in sling to keep upper end 
of humerus in glenoid cavity. 

January 26: Patient left hospital. Wounds almost closed. 
No discharge. The only treatment after operation was washing 
out cavity with carbolic acid solution, the exhibition of one 
grain of morphia and occasional laxatives. At no time was 
temperature above 101. 

February 6: Patient reports that he has regained complete 
use of arm. 

SURGICAL CLINIC. 

UNDER T. J. SULLIVAN, M. D. 



RAILROAD INJURY: SYME'S ANKLE-JOINT OPERATION. 



Reported by WARREN B. SEXTON. Ct.a88 of 1886. 



P. S. was brought to the University hospital, Thursday 
night, December 12, 1884. He had been employed as brake- 
man on the Michigan Central railroad, and while attempting 
to jump on the tender, after opening a switch, his foot slipped 
on a round stone, throwing him under the wheels and crushing 
his right foot. The skin was torn off for three fourths of an 
inch above the malleoli, all the bones of the foot except the 
oscalsis, astragalues and a few distal phalanges were ground to 



^110 RAILROAD INJURY. 

a powder. There had been but little hsemorrhage, and when 
brought to the hospital he seemed to be in little pain. 

Dr. Sullivan was summoned and decided on Syme's opera- 
tion. The patient was given chloroform, and Esmarch's band- 
age applied. The operation was successfully and quickly 
done, lasting only twenty iftinutes. As the skin had been vio- 
lently torn off above the malleoli in front, it was found necessary 
to make the plantar incision one inch further forward than usual 
An opening was made in the posterior part of the flap for 
drainage, and through this opening the ligatures on the arteries 
were drawn out. Tne posterior flap was then drawn forward 
and united to the skin by silk sutures. The edges were more 
closely adjusted with the horse-hair. The stump was dressed 
with oil silk and oakum and the patient placed in bed. 

After about three hours, the patient complaining of pain, he 
was given morphia sulphate, one-quarter gram, bypodermically, 
and, the pain continuing, the dose was repeated in half an hour. 
The balance of the night passed quietly and without much 

Eain. The dressing was cnanged at the end of twenty-four 
ours, and at this time the stump was doing nicely. On the 
fourth day it was noticed that the anterior j>art of the heel flap 
was beginning to lose its natural color, it soon turned to a 
greyish hue and the discharge became quite offensive. This 
showed that the crushing had involved more of the tissues 
than was anticipated and that propably an inch of the posterior 
flap would slough. Charcoal poultices were applied, and while 
hastening the separation of the dead tissues, caused the offensive 
odor to entirely disappear. As soon as the line of demarcation 
had formed, the most of the dead tissue was removed with 
scissors. The separation of the slough left a large portion of 
the inferior extremity of the tibia uncovered, and exposed so 
much surface that it was doubtful as to whether the balance of 
the flap would be sufficient to cover the bones. Soon the sharp 
edge rounded off by the separation of a thin shell of bone, 
granulations were thrown out, and the stump took on the 
appearance of a healthy healing sore: By this time the liga- 
tures had come awa^ and the drainage incision completely 
healed. The separation of the slough and clearing up of the 
wound occupied nearly three weeks. The patient complained 
of more or less pain up to this time and was given morphia 
almost eontinuously. This pain was probably due to the action 
of the secretions on the exposed nerves. Straps of surgeon's 
plaster, about two inches wide, were now applied in such a 
way as to draw the heel flap forward and to press the exposed 
granulations down. This dressing caused considerable pain, 
but after a few days passed off and its beneficial effects were 
plainly visible. 

As soon as the flap was well united and the discharge bad 
begun to lessen, grafts (twenty to thirty per day) were placed on 



RAILROAD INJURY. Ill 

the exposed granulations. Most of these were taken from the 
patient himself by catching a small portion of the skin on the 
point of a curved needle and cutting it ofiF with a bistoury. On 
two portions of the surface the grafts were small pieces of the 
lining membrane of an egg. These were given an equal chance 
:and could not be distinguished by their effects on the granu- 
lating surface from those taken from the patient. At this time 
the flap had become quite firmly united, corners were rounding 
•off, new skin forming in from tne periphery, and the discharge 
«o slight that it was not necessary to dress the wound more 
than once a day. The patient was up and around the ward on 
-crutches and had begun to think of going home. 

An epidemic of tonsilitis broke out just at this time in the 
hospital and the patient had a slight attack of the disease. No 
treatment except a gargle of chlorate of potash was given, and 
in a couple of days the inflammation nad nearly subsided. 
Having exposed himself by passing through a cold hall -way 
the symptoms returned. Saturday morning the tonsils were 
much enlarged and very painful. Aconite, quinine in free 
doses, steaming, were of no avail. Monday afternoon he was 
seen by Professor Maclean who lanced the tonsils and soft 
palate. Pus mingled with blood flowed freely and in an hour 
the swelling had materially decreased. The peculiarity of this 
attack was that ns soon as the tonsils began to enlarge the 
stump ceased to improve and the discharge was more free and 
slightly odorous, and the grafts, which were growing nicely up 
to this time, completely disappeared. By Wenesday the patient 
felt much better and as he wished to go home he was allowed 
to do so with directions to report in ten days. At the end of 
the appointed time he came back and in this time had improved 
-very much. The adhesive straps were now discontinued and 
the wound dressed by placing a piece of oil silk over the gran- 
ulations and wrapping in cotton. 

In this case it is of especial interest to notice the effect of a 
distant inflammation on the wound, — the wound making no 
progress until it had subsided. The extent of crushing and 
consequent separation of part of the flap made the convales- 
cence tedious. The excessive and lingering pain are contrary 
to the usual rule. Usually after the second day but little 
inconvenience is felt, and cases are common in which the 
patient is able to bear his weight on the limb as soon as the 
tenth day. 

The patient was again allowed to go home, with instruc- 
tions to return. One week later he presented himself. The 
healing process had gone on uninterruptedly and the stump 
was now almost completely covered with new integument. He 
was able to support nearly the entire weight of his body on 
the stump. The small remaining granulnr surfaces were then 
ordered to be dressed with lint, oiled silk and red wash. 



112 AN.£3THfiTICS IN EUBOPSAN HOSPITALS. 

EDITORIAL PERISCOPE. 



ANJESTHETICS IN EUROPEAN HOSPITALS. 



Among other observations made by Dr. David Prince, 
regarding European hospitals, which he communicated to the 
American Practitioner, the following on ansesthetics and modes 
of use is taken: 

As an ansesthetic the bichloride of methylene was employed 
in both the female hospitals of London. A cover is made to fit 
well over the mouth and nose, into which the vapor mixed 
with air is blown by means of a bellows, worked by hand or by 
foot, the air entering at the bottom of the fluid in a bottle and 
bubbling up through it, carrying the vapor with it. The efiect 
was very satisfactory in all the cases I saw it used. The 
patients, after being once etherized, were required to breathe 
the ansesthebic about half the time. 

In one of the hospitals ether was employed in one opera- 
tion just after the methylene had been employed in a previous 
operation. The action of the ether was very satisfactory,, 
though the patient breathed the eth6r a greater portion of time 
than had been the case in the other operation. Chloroform, 
however, is the favorite anaesthetic in London, given by drop- 
ping it upon flannel stretched across a circular loop of wire. 

In Paris the anaesthetic employed was uniformly chloroform, 
given upon a square folded napkin held over the mouth and 
nose. In the Hospital Saint Louis I saw it given by pumping 
the vapor from a receptacle standing upon a distant table into 
an inhaler fitted over the nose and mouth. After the patient 
was placed upon the operating-table the chloroform was con- 
tinued by dropping it upon a square napkin held over the 
mouth and nose. In the Hospital Charite it was given in an 
operation for cancer of the breast in a manner to indicate fear 
01 its efiects. The patient was first allowed to hold the napkin 
in her own hands, after which it was held by an assistant. 
The patient, however, was allowed to be fully awake during the 
latter half of the operation. She made great outcries, but the- 
operator proceeded without attention to her cries, and without 
any remark explanatory of the reason for the lack of ansesthesia. 

In the hospitals visited in other cities upon the continent, 
chloroform was the only anaesthetic which I saw employed. 
The mode was generally by means of flannel stretched across 
a wire concave frame, so that the nose projected into it. 

No fear of the occurrence of a catastrophe was generally 
exhibited. In an operation for the removal of a testicle by Dr. 
Bardeleben, in the Hospital Charite, in Berlin, the patient 
ceased to breathe. An assistant applied forceps to the tongue 
and drew it forward, and another assistant immediately applied 



TREATMENT OF INFANTHLE PAltALY8IB. US 

the poles of a galvanic battery (which always stood teidy^ in a 
ebavenient place) to the apposite sides of the neckj permitting 
the induction current to now once in about four seconds. The 
effect was to cause a contraction of the chest and a raising of 
the arms, with a contraction of the forearms. Dr. Bardeleoen. 
went on with the operation without any expression or appear- 
ance of alarm. By the time the operation was completed the 
respiration had become pretty well established. Dr. Bardeleben^ 
however, took the poles into his own hands and varied the 
application, producing various contractions of the included 
muscles. No attempt ^as made to change the patient from his 
position upon the back, much less to practice the ready method. 
Ko explanation whatever was made, nor was anything said to- 
indicate that anything unusual was happening. 



TREATMENT OF INFANTILE PARALYSIS. 



Dr. Bernard Roth read a paper upon this subject, before the* 
late meeting of the British Medical Society. After the acute 
stage is passed, the two guiding principles in the treatment of 
in&ntile paralysis, are: 

(1) To improve the power of those affected muscles which 
have still some voluntary power left. 

(2) To prevent the onset of any deformity, or if this ha* 
already occurred, to reduce it to a minimum. 

To carry out the indications of these principles the first 
thine to be done is to correct the lowering of temperature^ 
nearly always present in the limb or limbs. If one leg or arm* 
is affected you must not rest satisfied until it is as warm as the* 
healthy one. Upon rising in the morning the patient should^ 
be sponeed all over with tepid water, followed by brisk drying* 
and nibbing. The limbs must then be clothed with thick: 
woolen goods, or, better still, with goods lined with some kind; 
of fiur. Warm baths every evening, temperature from 48^ to 
100^ Fahrenheit, are most useful. These must be followed by 
rapid sponging of the entire body with cold water, thus correct* 
ing tiie tendency to undue sensitiveness to changes in tempera* 
ture. Next, ttMssage or rubbing is indicated. This must be^ 
practiced regularly and more frequently than is most generally- 
recommended. Tenacious adipose tissue is often found taking- 
the place of the wasted muscle, and through this the pressure 
of tne rubber's hands must be transmitted before the muscle^ 
can be brought under its influence. Massage can be performed 
in different ways and these can be roughly classed as xneading, 
circular friction with the thumb, feeling, and firm stroking 
down. These methods can be combined with any others that 
may occur to the operator, the principal point being to stimu- 
late tiie lowered nutrition of the muscles by artificial exer- 
(Ase. Besides these various motions the muscles can be exer- 



114 CARE IN CX)NVAL£SCENCE FROM PNEUMONIA. 

cised by putting them through their ordinary movements. 
Ab an illustration of the author's method we will quote what 
he says in reference to the muscles moving the should er-joint: 

"The patient lying on the back circumduction from before 
backwards is one of the exercises most easily taught, if there be 
any voluntary power, the elbow and wrist being kept extended, 
either voluntarily, or if that be impossible, by means of a wooden 
splint. To bring the scapula muscles into action, the patient 
lying supine wi*h arms drawn by the side of the trunk, or 
adjusted at right angles to the body, or extended upward by 
the side of the head, is told to resist the arms being brought 
forward by the surgeon from either of the above positions, 
and then voluntarily returned to the initial position against 
the surgeon's gradually yielding resistance, tne elbow being 
kept well extended. The rhomboidei and sub-scapularis mus- 
cles are chiefly brought into action in the secona movement, 
with the arms at right angles to the trunk." 

If the above indications are rigidly carried out, and the case 
has been seen early, the onset of any deformity can generally 
be prevented. If the case did not present itself until the 
deformity has occurred, it is often difficult to entirely remove 
it. To tiie suggestions above made must be added general con- 
stitutional measures. Milk should form a large element of the 
food. If there is any tendency to chronic constipation tepid 
water enemata is advised, rather than purgatives. These 
should be given on alternate days. The prognosis is favorable 
to improvement .within a month, if there be ever so small an 
amount of voluntary power left, and within three months there 
should be decided and marked improvement By this time 
the parents and friends will be properly trained, and the treat- 
ment should be continued by them as long as it is necessary. 



CARE IN CONVALESCENCE FROM PNEUMONIA. 



In a clinical lecture recently delivered at the Hospital of 
the University of Pennsylvania, Dr. Pepper makes the following 
precautions that should be observed in convalescence from 
pneumonia : 

'*We have been taught, by sad experience, to be careful 
during the convalescence of certain specific diseases, notably 
typhoid fever, but I fear we are not nearly so careful in the 
management of convalescence from local affections, particularly 
those of the chest. It is one thing for the temperature to fall 
to normal, the pulse to come down, and the breathing become 
easy, and quite another thing for the local lesions to be entirely 
removed. Under such circumstances the patient, if allowed to 
expose himself, is in danger of a relapse. Even if a relapse does 
not take place, something which is worse may develop. If a 
slight trace of inflammatory process be overlooked and the 



UREA NOT A CAUSE OF URiBMIA. 115 

patient be allowed to return to his ordinary occupation, it will 
remain and slowly take on a chronic degenerative change. The 
great majority of chronic troubles result from imperfectly cured 
local affections. This is pre-eminently true in regard to catar- 
rhal pneumonia, and it is also true in r^ard to pleurisy. The 
criterion by which we are to judge when it is proper for the 
patient to rise, take exercise and expose himself, is solely the 
result of phj'sical examination showing that all trace of local 
-disease has passed away. We cannot be governed by the 
general symptoms, for these may subside in a most satisfactorv 
manner, and yet the patient be far from being entirely cured. 
The care which has been insisted on in the acute stage should 
never be relaxed until the physical examination shows that all 
local change has passed away, unless, after pursuing a judicious 
course, and keeping up this care for a reasonable time, we find 
that the patient, in consequence of sqme constitutional defect 
or peculiarity, is passing into a chronic stage. Under such cir- 
cumstances further confinement instead of being a benefit, 
would probably injure the constitution. The patient is then to 
foe treated as one with a serious chronic disease, and although 
he is allowed to go about, it is under a most rigid hygienic 
regimen." 



UREA NOT A CAUSE OF UREMIA. 



At a stated meeting :>f the New York Pathological Society 
held November 26, 1884, Dr. G. L. Peabody said that at the last 
meeting of the society he had expressed the opinion that too 
much stress had been laid upon urea as a cause of uremia, his 
opinion being based more or less upon observations in the 
lower animals. Dr. Seguin had been of a similar belief, but 
apoke of experiments recently made in which it would seem 
tnat ursemic symptoms might be induced in lower animals bv 
injection of urea into the blood. Dr. Seguin had since informed 
Dr. Peabody where he could gain access to the records of the 
experiments to which he had referred, and Dr. Peabody took 
occasion to show to the society that it would require, according 
to the amount of urea necessary to produce death b}"^ injection 
into the circulation of the dog during these experiments, one 
pound and a half of urea to produce a fatal result in man. But 
it had been shown that in a man of one hundred and fifty 
pounds weight, dying of ursemia occurring in the course of 
Kidney disease, the blood contained only nine-thousandths of 
.one pound of urea. There might be apparent fallacies in this 
manner of drawing conclusions, but he thought it showed very 
conclusively that such experiments upon animals could give us 
little useful information as to the cause «of ursemia in man. 
.The injection into the blood of benzoate of soda or of sulphate 
of soda, agents which were not in themselves poisonous, would 



116 CHANCRE OF RYB-UD— INTESTINAL OBflTBUCTION. 

likewise prodace anemic symptoms. The experiments qaoted 
went no further than to show that the injection of a certain 
amount of any foreign substance into the circulation would 
produce death ; they did not show that uraemia was due to the 
presence of urea in the circulation. He had seen several cases 
in which there had been entire sunpression of the urine, ter- 
minating £ELtally, in which there haa oeen none of the so-called 
uraemic symptoms. 

CHANCRE OF THE LOWER EYE-LID PRODUCED BY INOCU- 
LATION. 



Dr. Van Harlingen, of Philadelphia, reports in the Polyclinic 
a case of chancre of the lower lid, produced in a man twenty- 
six years of age, by his chum who struck him a blow under the 
eve, then punctured the contusion witi^ a pen-knife and sucked 
the wound, which healed within one week. Two weeks later 
the patient noticed a small painless swelling at the seat of 
puncture, which slowljr ulcerated and at the end of seven weeks 
formed a typical erosion. This was accompanied by loss of 
appetite, emaciation, and enlargement of the peri articular, 
anterior, cervical and inguinal ^ands. He also suffered from 
a left epidydemitis and slight discharge from the urethra, but 
denied having gonorrhoea for seven years. Upon consulting 
the person who sucked the puncture it was found that he had 
contracted a chancre on the genitals six months previously, and 
was suffering from mucous patches on the tongue, cheeks, and 
in the throat. His body and limbs were covered with a syph- 
ilitic roseolse which at this time was gradually fading away* 
Later observations showed the inoculated patient to have a 
full fledged attack of syphilis. 

TREATMENT OF INTESTINAL OBSTRUCTION. 



In the discussion of the above subject in the Liverpool Med- 
ical Institution, Dr. Hyla Greves, deprecated (Lmcet) the 
employment of pur^tives, abdominal taxis, insufflation, etc., 
in the treatment of the early stages of acute intestinal obstruc- 
tion. Snemata, if used at all, should only be employed at the 
commencement of intussusception when the diagnosis was clear. 
He insisted on the necessity of withholding all solid food, includ- 
ing milk. Filtered beef-tea in small (quantities, ice, etc., are 
ample and sufficient to maintain life during the anxious period. 
Morphia should be ^ven in proportion to the pain; unless the 
diet be strictly limited, opium is of no use. It is best siven 
by the mouth, unless there be much vomiting; in the latter 
case morphia subcutaneously administered is better. A sur- 
geon should be consulted early; advice is generally called in 
too late for any chance of operating successfully. When the 



BRIGHT's PISKASE OP MALARIAL ORIGIN. 117 

fly mptoms of absolute obstraction exist, and their onset is sud^ 
den, a definite diagnosis as to the actual cause of the obstruction 
is not a sine qim non for operative interference. Therefore, 
when, in spite of a short trial — for example, two or three days 
— of palliative treatment, a strictly limited dietary, opium, 
raising of the foot of the bed (to encourage the gravitation of 
fluid towards the thorax and away from the site of strangula- 
tion) etc., the tongue becomes dry and brown, vomiting frequent 
and persistent, tne pulse, though perhaps decreased in fre- 
quency, becomes weaker, abdominal section should be per- 
formed, care being taken to guard the patient against shock 
during the operation by protecting the intestines with hot 
antiseptic cloths and maintaining the air of the operating room 
at a high temperature. The after-treatment must resemble in 
its essentials tnat recommended for the earlier stages. No solid 
food by the mouth till the boweln have acted spontaneously 
flhould be taken. 



BRIGHT'S DISEASE OF MALARIAL ORIGIN. 



Dr. I. E. Atkinson has been led to study all the cases of 
malarial fever coming under his observation during the late 
flummer and early fall of the past two years, at the Bay View 
Asylum. The American Journal of Medical Sciences puolishes 
his conclusions, which are as follows: 

(1) Transitory albuminuria is not uncommon in the course 
of malarial fevers, and is due to the intense visceral congestions 
eharacteristic of these affections. It only may endure through- 
out the height of the congestion, recurring with each return of 
this, or it may persist in the intervals, in which event a higher 

Srade of conjestion is attained, more nearly approaching a con- 
ition of acute inflammation. 

(2) In a proportion of cases varying with locality and type 
of prevailing epidemic, or individual conditions, inflammation 
of the kidney occurs, accompanied by dropsy and the usual 
symptoms of nephritis. 

(d) The usual form of malarial nephritis is the tubal and 
diStise variety. In this the inflammation seems to be most 
intense in the vicinity of the glomeruli. 

(4) Contracted kidney may occur as an advanced stage of 
malarial nephritis, either from long-continued or frequentlv 
repeated attacks of malarial fever, or from fibrotic changes such 
as may ultimately occur in ordinary tubal or difi'use nephritis. 
It is altogether improbable that this form of malarial renal 
disease ever occurs primarily as purely interstitial nephritis. 

(5) These changes may be induced by any form of malarial 
fever, though they more commonly follow chronic intermittent 
fever. 

(6) The tendency of malarial inflammation of the kidney 



118 TREATMENT OP WOUNDS— TREATMENT OF GOITRE. 

is toward recovery. But from the persistance of the impalu- 
dism or the intensity of the infiaramation, structural changes 
may be produced that are characteristic of chronic Bright'^ 
disease, when the gravity of the affection will be as that nrom 
chronic Bright's disease from whatever cause. 

(7) Treatment should be directed primarily against the- 
malarial intoxication, more especially in recent cases. A cor- 
rection of this will often be followed by a complete, though 
often gradual, subsidence of the nephritis. Even in more^ 
chronic cases, the malarial factor in the process should defin- 
itely be destroyed if possible, after, which the disease should 
be treated as ordinary Bright's disease. 



CAPILLARY DRAINAGE IN THE TREATMENT OF WOUNDS 



At the first meeting of the New York Surgical Society for 
the season of 1884 and 1885, Professor Thomas M. Markoe 
exhibited a specimen of recurring carcinoma of the arm and 
said {Annala of Surgery), he presented the case more especially 
to have an opportunity to call attention to a method of manag- 
ing surgical wounds, which had given him great satis&ction,. 
and which he believed had not been so extensively recognized 
as it deserved to be. Surgeons had for years used capillary 
drains in the shape of horse-hair, in the olden times silk, and 
more recently catgut leash, yet he believed that very few sur- 
geons had much confidence in the method for larse wounds, 
as it had been used for small ones and particularly for those of 
the scalp — a single thread or two of catgut being placed in the 
wound as a drain, the wounds thus treated doing extremely 
well. He felt the use of it in large wounds had certain advan- 
tages which were worthy of attention. In the first place, it 
exerted a positive force in drawing out from the cavity of the 
wound any fluids which might be retained there. If the drain 
was in a dependent position, the capillary force exerted by the 
leash would be almost as powerful as that of a siphon. The 
moment it was applied it would be seen that drainage com- 
menced taking place along sides and between the strands of 
catgut. 

THE TREATMENT OF GOITRE. 



The British Medical Journal gives the following resume of 
Dr. Morrell Mackenzie's recent paper on this disease. After 
pointing out the extreme importance of carefully distinguishing 
the various kinds of goitre, and excluding exophthalmic goitre 
from consideration, he maintained the following propositions: 

(1) Simple goitre (enlargement of the thyroid gland) ot 
recent origin, and occurring in young persons, can, in the 
absence of endemic influences, generally be cured by the admin- 



AFFECTIONS OF THE TONGUE. 119 

istration of iodide of potassium, and in many cases by coanter- 
irritation. 

(2) Fibrous goitre is best treated by parenchymatous injec- 
tions of tincture of iodine. 

(3) Cystic goitre can most readily be cured by conversion of 
the cyst into a chronic abscess, which is effected by emptying 
the sac, injecting a small quantity of perchloride of iron, and 
allowing it to remain within the sac for three or four days. 

(4) When the cyst is of considerable size it should not be 
emptied at once, but should be tapped two or three times before 
the injection is used. 

(5) Removal of the thyroid body is a dangerous operation 
which should never be performed for mere cosmetic purposes, 
nor even for the relief of urgent dyspnoea, except when less 
radical measures have failed. 



CHROMIC ACID IN AFFECTIONS OF THE TONGUE. 



Mr. Henry T. Butlin, F. R. S., gives in the Aviencan Journal 
cf Dental Sciences^ very good results from the use of chromic 
acid in certain affectioi^s of the tongue. 

In June, 1881, he treated two cases of glossitis with a ten- 
grain solution of chromic acid in water painted on the sore 
areas of the tongue three or four times a day. Both cases 
improved. A case of secondary syphilitic, depp and jagged 
ulcers of the tongue, and ulcerations of the inside of the cheek, 
which showed no improvement under hydrargyrum cum creta, 
iodide of potassium or liquor bichloride, were after a week's 
treatment with chromic acid solution, almost completely healed. 
Another case of flat mucous tubercles, due to secondary syphilis 
in the right border of the tongue, which had resisted treatment 
with hydrargyrum cum creta For about three and a half months, 
was almost completely cured in three weeks. 

Mr. Butlin has used chromic acid in several different inflam- 
matory conditions of the tongue, in many cases with most 
gratifying -success. In twenty-seven cases, twenty have been 
cared or greatly relieved, seven having received little or no 
benefit. The seven cases were either of chronic superficial 
glossitis, or of tertiary syphilis. The twenty included seven of 
superficial glossitis, and thirteen of various secondary syphilitic 
amotions. Mr. Butlin concludes that chromic acid cures with 
marvelous rapidity secondary affections, ulcers, mucous tuber- 
^ des, and conaylomata. It produces no appreciable effect on 
tertiary affections, gummata, extensive ulcers, or tubercular 
svphilides. Some cases of chronic superficial glossitis, with 
slight ulceration and renewed inflammation, are rapidly bene- 
fited by it. In cases of glossitis in which the tongue's surface is 
attacked by a fresh inflammation of great severity, glycerite of 
boracic acid and soothing remedies are more suitable, chromic 



120 CALOMEL IN DIPHT&EBIA. 

acid rendering these wor8e« He reports one ca«e of tertiary 
syphilitic ulcers of the tongue which was cured in about two 
months by chromic acid and mercury treatment, although it 
had obstinately resisted . purely anti-syphilitic treatment for 
many months. The strength of the solution usually employed 
is ten grains to one drachm of water; in some cases fifiieen 
grains to one drachm. The patient is told to paint the diseased 
parts three or four times a day with a camel's nair brush dipped 
m the solution. There is seldom any pain or discomfort; 
sometimes a little smarting at first. As the ulcers and mucous 

{>atche8 of secondary syphilis are in some patients quite pain- 
ill and exceedingly annoying &nd unyielding to the usual forms 
of treatment, a remedy as simple, and which promises such 
£Ood results should not be overlooked. 



COLOMEL IN DIPHTHERIA. 



The following extract is taken by the Medical News from an 
article by Dr; James Martin in the London Medical Press: 

I can safely say that in a bad case of croup, with which I 
5ira8 much more ramiliar forty to fifty years ago than I have 
t)een in later years, I always round calomel a good and useful 
remedy. I can recall one case, the very worst I ever saw 
irecover, in which death was momentarily expected for three 
llonj; weary days and nights, when, having given ninety-four, 
grains of calomel, a large, dark -green alvine evacuation was 
tfollowed by an immediate amendment and cure, and I saw the 
«ame infant grow up to be a young woman, dying at twenty-two 
years pf phthisis. But is not mercury supposed to have a 
peculiar enect in detaching the epithelium of tne mucous mem- 
orane? 

What pleased me most in the history of the cases was to 
find that in one of them a solution of the bichloride seems to 
have been used with advantage, for during the last six months 
I have treated every case of thrush or muguet, some ten or 
twelve which came under my care, bjr brushing the affected 
part over daily with a solution of the bichloride hydrargyrum, 
one grain to the ounce of distilled water. It acts more effectually 
and is neater in application than the sol. arg. nit. which I have 
hitherto used. 

In a case of typhoid pneumonia in an aged feeble woman I 
removed by their daily application a thick crust of cryptogame 
•dw muguet which was fully one eighth of an inch thick. My 
-experience in pure diphtheria has fortunately been very lim- 
ited, but it strikes me that by the use of Jansen's crystallized 
pepsine, if so powerful a preparation as is represented be used 
4is a solvent and followed by a solution of the bichloride as a. 
germicide, we would have a useful and neat local application; but 
I must say later the old rule in prosody — "umsteplura doednt,^'' 



r 



OONDEN8ATIONB. 121 

CONDENSATIONS. 



Fob several months the Atlantic Medical and Surgical Journal 
•did not appear among our exchanges. The absence was oon- 
spicuoos. Its return is greeted with a hearty welcome. 

Pbofkssor Da Costa, a short time since exhibited a patient 
at his clinic, in whom an attack of facial erysipelas was aborted 
by the hypodermic injection of a third of a grain of the muriate 
of philocarpine. 

Jequibitt is a dangerous drug, sa^s Vossius, and ought 
never to be used in ophthalmic practice, since, while it does 
not cure either pannus or granulations, it places the cornea 
in extreme peril. 

The Lancet says that the name of Prince Albert Victor will 
shortly be placed upon the student roll at the Middle Temple, 
and that of Prince Charles, of Bavaria, is to be counted among 
the medical graduates of Austria. 

The use of nursing bottles is forbidden in the Hospital 
Materniti, Paris. Infants are fed with a spoon or from a glass 
vessel. If this course was persued in private families the mor- 
tality of infants would be greatly diminished. 

A NEW theorv of foetal circulation is advanced in the Amerir 
can Journal of Obstetrics by Jerome A. An Person, M. D., of San 
Francisco. He believes the child to be nourished from absorp? 
tion of albumen from the amniotic fluid, and not from the 
utero-piacental circulation, the placenta acting simply as a 
respiratory organi 

Chloral hydrate is being substituted for cantharidies, as a 
vesicant. The powdered chloral is dusted on ordinary adhe- 
sive plaster, gently heated and applied to the part. In ten 
minutes blisters are produced. The advantages claimed for it 
are: rapidity of action, almost painless, and free from the bad 
effects resulting from absorption of cantharidies. 

Carqolized Water to Prevent Shock tn Litholopaxy. — 
t>T. Edniund Andrews, of Chicago, presented to the Section of 
Surgery and Anatomy of the American Medical Association the 
following: The power of carbolic acid to benumb the sensibility 
of nerves, when applied locally, is well known. For several 
years I have acted on this hint in the new operation of litholo- 
paxy with a view of blunting the impressibility of the urethral 
and vesical nerves. 



122 OONDENSATIONS. 

The preliminary report of the EngliBh Cholera Commission 
has been presented by Dr. Klein and Dr. Gibbes. Their results 
are in direct opposition to those of Dr. Koch. They claim thai 
the comma bacilli are not characteristic of cholera, and state 
that they have discovered a straight bacillus which is more 
constant in choleraic discharges than the comma variety ; that 
the comma bacilli occur in "epedemic diarrhoea, dysentery^ 
and in intestinal catarrh associated with phthisis." 

The members of the German Society of Public Hygiene^ 
have been recently carrying on a prolonged discussion on the 
'^ Abuse of Alcoholic Liquors." At the close of the debate Herr 
Mehlhausen, referred to the extended observations which had 
^een made in the Prussian army, with reference to the serving 
rations of schnapps to soldiers when in the active service of a 
campaigp. The army surgeons had thoroughly tried the experi- 
ment, with the result of their abandoning spirits for tea and 
coffee. 



Manganese as a Remedy in Menstrual Troubles. — Dr. F. 
H. Martin read a paper at the Chicago Medical Society, Janu- 
ary, 1885, on the power of manganese to relieve certain forms of 
menorrhagia, metorrhagia, and amenorrhagia. He believes the 
remedy is a direct stimulant to the uterus and its appendages. 
Like nickel, zinc, iron and silver, manganese acted as a tonic to 
the blood in cases of ansBmia, chlorosis, etc., but it could not be 
owing to that fact alone that it exerted its peculiar influence 
on the catamenia, for its action was too prompt. It might be 
given in the form of permanganate of potassium or as the 
binoxide of manganese. The former should be dissolved in 
water, and, when possible, it should be given after meals. The 
binoxide, although less readily absorbed on account of its 
insolubility, was not irritating, and could readily be admin- 
istered in pill form. 

Treatment of Chilblains. — The disagreeable itching caused 
by chilblains can be very much relieved by soaking the feet in 
warm water, then thorougly applying pure white lard to the 
affected parts. This is beneficial only in those cases in which the 
skin is dry and hard. Glycerine can be used in the same way in 
those cases in which the skin is soft and congested. The fol- 
lowing application is one that will always give instant relief in 
the worst cases, and often end in a permanent cure. The only 
objection is that the acid will destroy the stockings: 

B. Acid Bulph 3j. 

Oletim ohvffi ^iij. 

Spts tereberth 3j. 

Mix the oil and turpentine first, then add gradually the sul- 
phuric acid and apply morning and evening. 



NEW PUBLICATIONS. 128 

NEW PUBLICATIONS. 



A SYSTEM OF PRACTICAL MEDICINE BY AMERICAN AUTH- 
ORS. Edited by William Pepper, M. D., L. L. D., Provost and Pro- 
fessor of the Theory and Practice of Medicine and of Clinical Medi- 
cine in the University of Pennsylvania. Assisted by Loais Starr, 
M. D., Clinical Professor of Diseases of Children in the Hospital of 
the University of Pennsylvania. Volume I: Pathology and Gen- 
eral Diseases. Philadelphia: Lea Brothers & Co., 1886. 

We felt a fall sense of American pride when leafing through 
the firet volume of " A System of Practical Medicine oy Amer- 
ican Authors." This comprehensive work, which will be cora- 
fleted in five volumes, has been undertaken, by its editor, Dr. 
epper, the eminent author, and distinguished teacher of the 
theory and practice of medicine, "in the belief that by obtain- 
ing the co-operation of a considerable number of physicians of 
acknowledged authority, who should treat subjects selected by 
themselves, there could be secured an amount of practiciJ 
information and teaching not otherwise accessible." 

The authors of the various subjects have been selected, as 
the title implies, exclusively from American practitioners, 
because it was felt that the time had arrived for the presenta- 
tion of the whole field of the theory and practice of medicine 
as it is actually taught and practiced by ltd best representatives 
in this country. While this restriction has been inade, the 
importance of the study of special studies by European inves- 
tigators has not been ignorea, they being fully recognized and 
acknowledged. 

Until a few years ago, foreign authors of general medicine 
had the monopoly of the subject. American patients were 
treated by American phvsicians read up on foreign works. 
These facts are recognized by our distinguished physicians, for 
within the last two years several works on "Theory and Prac- 
tice " have been sent to the press by American authors, and the 
cordial and willing manner which they entered upon the labors 
of this con-joint undertaking, is but another evidence. 

The articles in volume one are arranged under two heads. 
First, those pertaining to General Pathology and Sanitary 
Science; second, on General Diseases. 

Under the first are: General Morbid Processes, by Reginald 
H. Fitz, M. D., Shattuch Professor of Pathological Anatomy in 
Harvard University, Boston; General Etiology, Medical Diag- 
nosis, and Prognosis, by Henry Hartshorne, M. D., L. L. D.,late 
Professor of Hygiene in the University of Pennsylvania, Phila- 
delphia; Hygiene, by John S. Billings, A. M., M. D., L. L. D., 
(Eainburgh) Surgeon United States Army, Washington ; Drain- 
4^6 and Sewerage in their Hygienic Relations, by George E. 
Warning, Jr., Member of the Institute of Civil Engineers, 
of Sanitary Drainage, Newport, Rhode Island. 



• 



124 NEW PUBLICATIONS. 

On General Diseases are the following sabiects: Simple Con- 
tinaed Fever, Typhoid Fever and Typhus Fever, bv James H. 
Hutchinson, M l3., Physician to the rennsylvania Hospital and 
to the Children's Hospital, Philadelphia; Relapsing Fever, by 
William Pepper, M. D., L. L. D., Provost and Professor of the ' 
Theory and Practice of Medicine and of Clinical Medicine in 
the University of Pennsylvania, Philadelphia; Variola, Veri- 
cella. Erysipelas, by James Nevins Hyde, M. D., Professor of 
Skin ana Venereal Diseases in the Rush Medical College, Chi- 
cago; Vaccinia, by Frank P. Foster, M. D., New York; Scarlet 
Fever, by J. Lewis Smith,. M. D., Clinical Professor of Diseases 
of Children in the Bellevue Hospital Medical College, New 
York; Rubeola and Rotheln, by W. A. Hardaway, A. M.,M. D., 
Professor of Diseases of the Skin in the Saint Louis Post Grad- 
uate School of Medicine and in the Missouri Medical College, 
Saint Louis, -President of the American Dermatological Asso- 
ciation; Malarial Fevers and Yellow Fever, by Samuel M. 
Bemiss, M. D., Professor of Theory and Practice of Medicine 
and Clinical Medicine in the University of Louisiana, New 
Orleans; Parotitis and Pertussis, by John M. Keating, M. D., 
Visiting Obstetrician and Lecturer on Diseases of Women and 
Children to the Philadelphia (Blockley) Hospital, — Surgeon to 
the Maternity Hospital, — Physician to Saint Joseph's Hospital, 
Philadelphia; Diphtheria, bv Abraham Jacobi, M. D., Clinical 
Professor of Diseases of Children in the College of Physicians 
and Surgeons, New York, etc. ; Cholera and Epidemic Cerebro- 
spinal Meningitis, by Alfred Stille, M. D., L. L. D., Emeritus 
Pr^essor of Theory and Practice of Medicine in the University 
of r^nsylvania, Philadelphia; Plague and Enfluenza, by James 
C. Wilson, A. M., M. D., Phvsician to the Jefferson Medical Col- 
lege Hospital and to the Philadelphia Hospital, Philadelphia; 
Leprosy, bv James C. White,, M. D., Professor of Dermatology 
in Harvard University, Boston; Dengue, by H. D. Schmidt. M. 
D., Pathologist to the Charity Hosoital, New Orleans; Rabies 
and Hydrophobia, Glanders and Farcy, and Authrax (Malig- 
nisint Pustule), by James Law, F. R. C. V. S., Professor of Veter- 
inary Science in Cornell University, Ithaca, New York ; Pyaemia 
and Septicaemia, by B. A. Wilson, A. M., M. D., Surgeon to the 
Jersey City Charity, Saint Francis, and Christ Hospitals, Jersey 
City ; Puerperal Fever, by William T. Lusk, M. D., Professor 
of Obstetrics and Diseases of Women and Children in the 
Bellevue Hospital Medical College, New York; Beriberi, by 
Duane B. Semmons, M. D., late Director, Physician and Sur- 
geon-in- Chief of the Government Hospital, also Consulting Sur- 
geon to Prison and Police Hospitals at Tokohama, Japan. 

Several articles on account of the present great prevalence 
throughout the country of the diseases discussed, will be quoted 
from for the immediate benefit of the reader. In the article on 
erysipelas the disease is regarded as highly contagious, the pro- 



NEW PUBLICATIONS. 126 

phy lactic treatment being that of all contagious diseases. "It 
involves isolation of the affected individual, disinfection of 
body and bed clothing before the latter are again employed 
upon the persons of others, and destruction by nre of all dress** 
ing which have been in contact with the integument." The 
extolled and much used external remedies are all enumerated, 
but it has never appeared to us that they have any effect on 
the course of the aiseiise. The simple dressing of white cotton 
wadding we regard inore efficient in preventing the flying 
around of exfouations and greatly more comfortable to the 
patient. The external use of iron is recommended in full 
doses, but it is doubted if it possesses power on the disease. 

On diphtheria both sides of the parasitic cause of the dis- 
ease are carefully stated. Dr. Jacob! does not commit himself, 
but rather favors the specific bacteria origin, and quotes Pan- 
um's words as what seems to be the soundest expression of all 
our knowledge on the subject who says: "It is a matter of 
rejoicing that physicians have come to the conclusion that cer- 
tain microscopic organisms, be they considered vegetable or 
animal, and designated as bacteria, fungi, monads, micrococci or 
bibriones, do not exist merely in the minds of theorists as 
causes of disease, but are in reality enemies that must be com- 
batted with all the known efficient weapons in our possession. 
But while thus rejoicing it must be borne in mind that we have 
but a feeble insight into the relation between these organisms 
and diseases, and in order to affect that much-desired ad- 
vance in scientific knowledge — a matter of considerable import- 
ance in the practice of medicine — it is necessary not only to 
grasp at isolated data, but carefully and deliberately to observe 
and study all the facts before us, and even to devote some atten- 
tion to those which would tend to prove that there are bacteria and 
fungi which, under certain circumstances, are perfectly harmless, 
and that even some of the malignant ones among them do not 
commit all those outrages with which they are charged, directly 
and personally." Upon the treatment Dr. Jacobi strongly 
advocates immediate energetic treatment. The best treatment 
is frequently of no service because administered too late and in 
too small doses. " If I have ever had cause to feel contented 
with the results of treatment in diphtheria, it is owing to the 
fact that I lost no time." Medicines must not be given that 
are apt to derange the stomach, for this reason alcoholic stimu- 
lants must be given in ftiir dilution. The nourishment of the 
patient is regarded as a matter of the greatest importance. He 
admits that on general principled care must be taken in regard 
to the diet of febrile patients, *'but we must bear in mind that, 
when the lymphatic vessels are kept empty and no new and 

{>roper material is introduced into them the absorption of 
ocally existing substances is proportionately increased. Hun- 
gry lymph-vessels are the organism's fiercest enemies." Chlor- 



126 NEW PUBLICATIONS. 

ate of potassium and chlorate of sodium are regarded prophy- 
lactic agents. Among local remedies, steaming, cold applica- 
tion where there is great pain and swelling of the glands, lime- 
water, glycerine, lactic acid, pepsin, neurin, papagotin, chinolin 
and pilocarpine, tupentine inhalations, ammonium chloride, 
chlonde of iron and quinine are mentioned. Cauterization of 
the membrane is condemned unless done thoroughly. 

The design ot the work is well conceived, and its projectors 
will receive the thanks and gratitude of the American profes- 
sion. In no other country is scientific advancement so closely 
followed as among American specialists in medicine, and, as 
the articles comprising this work come from their pens, the 
complete work will represent medical science as believed and 
practiced by our authors and teachers. Aside from its text the 
volume before us has been masterly executed in every respect. 
Its ]>aper, press-work and binding are such as have made the 

f>raise-worthy firm of Lea Brothers & Co. so eminent as pub- 
ishers of medical works. 



THE SCIENCE AND ART OF SURGERY: A TREATISE ON SUR- 
GICAL INJURIES, DISEASES AND OPERATIONS By John 
Erie Erichseii, F. R. S.« L. L. D., F. R. C. S., Sargeon Extraordinary 
to her Majesty the Qaeen ; Ex-President of the Royal College of 
Sarp^ns of England, and of the Royal Medical and Chirurgical 
Society; Emeritos Prolessor of Surgery and of Clinical Surgery in 
University College; Consulting Sargeon to University College Hos* 
pital, and to many other Medical Charities. Eighth edition revised 
and edited by Marcus Beck, M. S. and M. B., London, F. R. C. 8.. 
Surgeon to University College Hospital; and Professor of Clinical 
Surgery in University College, London. With nine hundred and 
eighty-four engravings. Volume I: Eleven hundred and twenty 
four pages. Cloth, leather and half Russia. Philadelphia: Henry 
C. Lea's Son & Co., 1884. 

A work that has been familiar to the profession for as many 
years, and which has been as highly recommended to students 
by their teachers as "Erichsen's Surgery " does not need to have 
its ** eighth edition " introduced by any extended review. From 
the time it was announced that a new edition was being pre- 
pared for the press, medical student and old practitioner, were 
alike impatient for its appearance. 

The amount of change to be made in the revision of a work 
is in proportion with its completeness, and with the advance of 
the subject or science upon which it treats. A revised edition, 
of a work as complete in principle and detail as " Erichsen,*' 
and upon a science that has constantly contributed to all its 
departments as much new material as the science and art of 
modern surgery,. must have much eliminated that is old, and 
more that is new assimilated. The labor required in this work 
was greater than the author could himself perform ; be, there- 
fore, sought the assistance of several colleagues and co-workers. 
Those parts relating to surgical pathology have been rewritten 



NEW PUBLICATIONS. 127 

by Mr. Beck, who also assisted the author in the revision of 
those portions that appertain to clinical and operative surgery. 
The chapter on surgical treatment of uterine and ovarian dis- 
eases was written over by Dr. William A. Meredith. 

In the preface to this edition Mr. Erichsen says : '^ It is not 
sufficient that the teachings of a scientific art, such as surgery, 
should be sound in those general laws that constitute its prin- 
-ciples. It must also be accurate in those minute details that 
are necessary to its successful practice, and above all just in its 
€Stimate of the labors of others." The author has been most 
conscientious in carrying out this declaration. Beins a firm 
-supporter, by word and act, of the *' antiseptic method," in his 
general remarks on operations, he states the general principle, 
prefaced with the remark : ^^ However much the details of the 
unttieptic method may be varied in the course of time and by 
the introduction of new chemical ascents, the grand principle 
which sub-lies it, and on which the whole superstructure of its 
details is built, will run on intact and unchangeable." But 
-everywhere through the volume where the antiseptic dressings 
are recommended the details for their application, in ways best 
suited for each class of wound and injury are faithfully enumer- 
ated. In the chapter devoted to "Injuries of Soft Parts," " Lis- 
terism " is minutely described, but the writer does not believe 
the practice of the antiseptic treatment of wounds " necessitates 
the use of any special antiseptic agent or any special material 
for dressing." 

Since the previous edition there has been such a rapid 
•development, particularly in the science of surgery, that many 
chapters have been almost written anew, and all through the 
worK there has been a general incorporating of much that is 
new, which has materially enlarged the volumes. In exercising 
the proper care to exclude theories, which have not been thor- 
oughly tried and proven, many that are valuable and estab- 
lished may be omitted.. In this respect we think Mr. Erichsen 
has unintentionally erred. In his chapter on " Fractures," we 
are disappointed to see that no mention is made of several 
improved methods of treating fractures, that have for several 
years been taught and practiced by some of our most prominent 
American surgeons. Very prominent among these omissions is 
the new method, advanced by Dr. Frank Hamilton'*' of treating 
^actures of the humerous. Dr. Hamilton condems the short 
rectangular splint and recommends the use of a long straight 
splint with the view of preventing the occurrence of non-union 
which so frequently follows fracture of this bone. The superi- 
ority of the straight over the flexed position of the arm, is seen 
in the cases t reported by Dr. Donald Maclean, Detroit, Michi- 

* Hamilton on Fractures and Dislocations: Seventh edition. 

tTns Physician and Scaobon: May, 1880; July, 1882: December, 
1884. 



128 NEW PUBLICATIONS. 

gan. But even more conspicuous is the &ilure to mention the- 
well established views of Dr. L. S. Pilcber, Brooklyn, on the 
mechanism and treatment of CoUes's fracture of the radius. Dr. 
Pilcher attributes* the deformity attending this fracture to be 
due to the presence of a strong oblique fasciculus of the 
anterior ligament of the wrist. The backward displacement of 
ihe carpus, and the attached radial fragment put that ligament 
upon the stretch, limiting all motion until relaxed. The dorsal 
periosteum is also torn up, making it difficult to I'educe Uie 
nra^ment until the strain upon this periosteal ligament is 
relieved by forced extension of the hand. The fragments being 
thus disengaged the carpal one can be easily pressed down into- 
position. In the treatment of Colles's fracture Dr. Pilcher dis- 
cards all splints, regarding them unnecessary. 

With a few other mmor exceptions the work has been 
brought abreast with the advancements of modem surgical 
science. From its arrangement and clear statement of facts and 
details there is for student and practitioner no better text-book 
on surgery published. 

BOOKS AND PAMPHLETS RECEIVED. 



HISTORY OF THE UNIVERSITY OF MICHIGAN. By Eliiabeth 
M. Farrand. Ann Arbor: Register Pablishing House, 1886. 

REPORT OF PROCEEDINGS OF THE ILLINOIS STATE BOARD 
OF HEALTH. Adjourned meeting, Springfield, February 5 to 6, 
1885. 

BIENNIAL MESSAGE OF JOHN M. HAMILTON, GOVERNOR OF 
ILLINOIS, TO THE THIRTY-FOURTH GENERAL ASSEM- 
BLY. Springfield : H. W. Bokker, State Printer and Binder, 1888. 

EXTENSIVE BURN INVOLVING THE CAVITY OF THE KNEE- 
JOINT. Read in the Section ot Su^ery at the Annual Meeting 
of the British Medical Association. Reprint from the BriHih Mef- 
ioalJaumdl, 

REPORT OF THE BOARD OF TRUSTEES OF THE MICHIGAN 
ASYLUM FOR THE INSANEjPOR THE YEARS 1883 AND 
1884. By Authority. Lansing: W. S. George <& Co., State Printers 
and Binders, 1884. 

TRANSACTIONS OF THE AMERICAN DERMATOLOGICAL A8S0- 
CIATION. Eighth Annual Meeting held at Highland Falls, near 
West Point, New York, on the 27th, 28th, and 29th of August, 
1884. Official Report of the Proceedmss. By the Secretary, W, 
T. Alexander, A. M., M. D., New York, 1884. 

QUIZ-<X)MP£NDS. Number IX. A Compend of Surgery for Students 
and Physicians. By Orville Horwitz, B. S., M. D., Resident Physi- 
cian at the Pennsylvania Hospital, and late Resident Physician at 
the Jefferson Medical College Hospital, Philadelphia. Second 

I edition, revised and enlarged. Sixty-two illustrations. Philadel- 
phia: P. Blakiston, Son £ Co., 1885. 

^Medteal Record : July 25 and 30, 1881 . Thb Physician and Subgbon : 
December 1, 1884. 






MASSAGE IN QYNJBOOLOOY. 129 

MEDICAL DIGEST. 



MASSAGE IN GYN^CX)LOGY. 



While in some other countries, especially in France and 
Scandinavia, soon after the re-introduction of massage into ther- 
apeutics, there appeared a series of publications on its employ- 
ment in gynsecolosy, and discussions of the subject took place 
in various mediccQ societies; among us the contributions to a 
knowledge of the subject have been few, and this is especially 
true with regard to clinical observations. Our newer manuals 
express themselves with reserve,' and rest satisfied with merely 
a curt acknowledgement of the existence of the method. 

T^ere was no reason at first to regret the circumstance. The- 
reeults of massage were certainly for a time exaggerated ; the- 
process soon fell into the hands of the humbler sort of practi- 
tioners and quack specialists, and it must be frankly admitted' 
that it was through such people that the process first found a 
footing in the field of gynsecology. This circumstance did not 
altogether tend to beget confidence, and when we remember 
that gynaecologists have of late been reproached with too great 
diligence in treatment, it is easy to explain why many who 
have employed message have been cautious about publishing 
their. results. But already the results of massaj^e in surgery, 
and even in gynaecology in the hands of some of the operators 
bv profession, have been so striking that the subject urgently 
challenges an experimental investigation. 

To wis challenge I respond, and inasmuch as I have for twa 
and a quarter years somewhat freely employed massage in gyne- 
cology, I should like to-day to take the liberty of acquainting 
you with the results obtained in order to elicit from you, as 
representing the opinion of Germany, some opinion with regard-, 
to massage. Time compels me to be brief. I intend, therefore,, 
to state my views and results in a number of exactly formulated 
and easily discussed propositions, retaining details and case- 
histories for future publication. 

'(1) The employment of massage in gynsecological therapjeu- 
tics aims at the acceleration of the absorption of pathological 
products, the stimulation of the circulation, the stretching of 
shrunken and cicatrical tissue, rarely the production of contrac- 
tions. Parallel with these objects, the following diseased con- 
ditions come under consideration as the most suitable for treat- 
ment by massage, namely, transudations, exudations, metritis,, 
loss of tone, cicatricial stricture, and contractions with their 
resulting conditions, rarely neoplasms. 

(2) Message should never be employed except when all 
other therapeutic agents have failed. Every course of treat- 
ment by massage is tedious, often lasting for months, and it is 
I 



130 MASSAGE IN GYNECOLOGY. 

almost always painful. CJonsequently it is not only better 
before having recourse to massage to give trial to other and 
simpler methods of treatment, but it is also more satisfactory 
because patients decide more readily to submit when other 
measures have failed. This rule may be readily set aside by 
others, but with me the more experience I have of massage the 
more decidedly does it become an axiom; for only in this way 
can we protect ourselves from disappointment and save the 
method from discredit. * * * 

(3) Another previous condition to the practice of massage 
is an exact differential diagnosis, the result of careful combined 
examination. * * * We must not hesitate to make 
an examination under anaesthetic in order to make the diag- 
nosis clear and definite, and such a proceeding has repeatedly 
saved me from errors in diagnosis, especially in estimating the 
amount and the consistency of exudations. The process of dif- 
ferentiation is essentially lightened when the pnysiciati pre- 
cribes massage only for patients whom he has already had 
under treatment. 

(4) Gynaecological massage divides itself into an external 
and an internal. External massage is verv little used, but it is 
advisable in most courses of treatment to begin with it, if only 
to test the amount of sensibility. The circumscribed employ- 
ment of external massage depends upon the fact that only in a 
small number of patients is it possiole by external manipula- 
tion to produce any effect upon the organs of the true pelvis, 
because every kind of massage requires a certain amount of 
resistance for its eflBciency. The employment of massage as a 
test for sensitiveness is suitable for most patients, but not for 
all; there are women who are completely intolerant of internal 
measures, and who cannot bear external manipulation. The 
mode of applying external massage is almost exclusively by 
friction, a process concerning which it was well remarked by 
Hosengeil that it is easier to show than to describe. For 
gynaecological purposes it may be conducted as follows: The^ 
palm of the hand is laid flat and supported upon the center of 
the ilium, the rami of the pubis, the surface of the sacrum, or 
the psoas muscles, then, while the abdominal muscles are as 
much relaxed as possible, with the tips of two or more fingers 
the operator seeks from the front or from the side to work down 
upon the part or organ to be influenced, and to draw it against 
one of the underlying parts, or to press it down upon or against 
some resisting object * * * 

(5) Internal massage divides itself into active and passive. 
The active form consists in a process of kneading, of pulling 
and pushing, by means of the two hands working together, the 
fingers of one being placed in the vagina (more rarely in the 
rectum), of the other on the abdomen. 

The passive form depends upon the introduction of cylin- 



MASSAGB IN QYNJEOOLOQY. 131 

ders into the abdomen for the purpose of widening and of 
stretching the tissues. Active or '^combined massage," is that 
which has hitherto been more frequently practiced. * * 
* It consists in kneading the affected part, that is to 
say, the operator tries from the vagina and abdominal surface 
to take the part between his fingers and to rub and press and 
squeeze it. With this process of kneading {pdtrissage) may be 
associated a form suitable for gynaecological cases, consistins in 
pressing and drawing the parts in various directions according 
to the object to be attained (der Zugdruck). It is especially 
ef!icaci6us in dealing with cicatricial bands, and often affords 
much better results with less pain, than the kneading process. 

♦ s|c s|c 

Few women can tolerate the process more than once or 
twice a day, from ten to fifteen minutes each time. Apart from 
the pain, a marked impression is produced on the nervous 
system. I entirely omit any reference to sexual excitement, 
which can easily be avoided, and which, for my own part, I 
have never observed, but I refer to a nervous excitement of 
quite a different character, which is often produced by gynseco- 
logical manipulations, even in the most unimpressible women. 
On the other hand, it has been shown with regard to massage 
for any purpose that only the courses of treatment which are 
regularly and systematically carried out with as few interrup- 
tions as possible are followed by any satisfactory result. The 
same is true in gynsecology, and the performance of the process 
of active massage only twice or three time a week produces lit- 
tle or no effect. From this dilemma I tried to escape by the 
introduction of passive massage. [The description here given 
of this process proves it to be somewhat similar to that some- 
times carried out in the preparation of a patient for the opera- 
tion of vesico-vaginal fistula when there are cicatrices in the 
vagina, or in case of vaginismus. A series of vulcanite cylin- 
ders are employed to gradually dilate the parts contracted b^ 
cicatrix or spasm. The author claims for this process that it 
is the only means by which the sittings of the course of active 
massage can be reduced to two or three a week.] Massage 
may be advantageously combined with baths or with other 
thempeutic agents, such as iodine or iodoform. * * * 

(7) a — An absolute contra-indication is every acute disease, 
even if it runs its course without fever, and every subacute dis- 
ease which has been accompanied by rise of temperature in its 
acute stage. In cases of exudation it is a safeguard againt mis- 
haps if we make two to three months absence of fever a condi- 
tion of employing massage; in the case of hsdmatocele we may 
make a beginning six to eight weeks from its occurrence. 
6— Conditional contra-indications are: pregnancy, suspicion of 
consumption, and perhaps latent gonorrhoea. In the first 
months of pregnancy we may cautiously employ active massage 



132 MAS8AQE IN GYNiECOLOGY. 

upon painful cicatricial bands. In the latter months passive 
massage may be used for cicatrices of the vagina from whatever 
cause. 

In a lady belonging to a consumptive family with catarrh 
of the apices I once observed, after massage for exudation, an 
attack 01 pleurisy which may have been set up by the process ; 
* * * in undoubted latent gonorrhoea I have twice 
during massage observed joint affections very painful and asso- 
ciated with slight fever, which I consideretd to be gonorrhoeal 
rheumatism. * * * 

The following are the results obtained : * 

From July, 1882, to July, 1884, one hundred and two women 
were treated by massage (not counting the incomplete cases of 
the last few months). 

Of these we set aside at once sixteen who would not go on 
with the course owing to the pain or from some other cause. 
Fourteen of these sixteen cases occurred during the first five 
months, only two in the last nineteen monihs, proving that it was 
not the metnod itself, but the operator that was at fault. With 
increasing experience and greater dexterity, the cases of excess- 
ive painfulness became rare. Among the remaining eighty- 
six there were five cases of new formations. Encouraged by 
the success of Winiwarter, I tried massage in three cases of 
small intra-ligamentary tumors; two of them disappeared with- 
out any concomitant bad symptoms and without return; the 
third developed apace and came later for operation. The 
attempt to aid the general enucleation of subumcous fibroids 
failed in two cases. 

Thirteen times was massage undertaken for prolapse of the 
uterus. The chances of a favorable result were small on path- 
ologico-anatomical grounds, but inasmuch as the professional 
masseures boast of successes in this condition, I have from time 
to time given it a trial. Only once in case of slight prolapse 
was a cure effected; twice there was slight improvement; in all 
three I attributed the result to the improvement of the general 
health of the patient. In marked prolapse, or in complete pro- 
cidentia, conditions in which the Swedish masseurea claim to 
have succeeded, I never saw any kind of improvement. * 
* * Further, ten cases of chronic metritis and subin- 
volution were treated by massage; the number may seem small, 
but it should be remembered that the majority of such ailments 
are cured by simpler measures. The wnole ten cases were of 
specially long duration and obstinacy, so that a complete cure 
in four cases and improvement in three is a notewortny result. 

Of eighteen cases of exudation (including five cases of hsemat* 
ocele) eight (including two of hematocele) were completely 
cured, two were relieved to the extent of an entire absence of 
symptoms, and a less degree of improvement occurred in other 
three. In the three cases already mentioned (one of pleurisy, 



A NEW EXTRACT OF ERGOT. 133 

• 

two of gonorrhoeal rheumatism) harm was done. I have never 
had a case in which fresh inflammation wns set up in an old 
•exudation, such as is mentioned by some operators; but I have 
been extremely cautious in applying massage to exudation cases. 
The largest class of cases suitable for massage are the old 
cicatricial, contracted remnants of exudation, callous cicatricial 
bands upon a basis of simple inflammation, with the changes 
in the position of the uterus and ovaries depending upon these 
conditions. Out of forty such cases twenty-four were cured, 
and of ten improved eight were in a clinical sense also cured. 

* 4c 4e 

It would be foolish to call these results brilliant; it would, 
however, be a mistake to overlook their value. If we remember 
that in every case other therapeutic measures had preceded, 
and when we think how little success we have attained in the 
cure of old exudations and the dissipation of obstinate cica- 
tricial bands, we must admit that the results here obtained are 
sufficient to challenge a further trial of massage in gynecology. 
— Abstract of paper read by Dr. Prochownik at the Veraamm- 
-burg Deutacher Naturforscher Aerzte, ^Obstetric Gazette. 



A NEW EXTRACT OF ERGOT. 



In the department of Obstetrics and Gynsecology in the 
Medical Review, Dr. Engelmann writes, of the new extract 
(extractum secalis comuti, Denzel), and says: ** Great difficulty 
has been experienced with the various forms of extract of 
•ergot. Notwithstanding many improvements have been made 
of late years, it is still unreliable. The various preparations, 
differing in strength, have by no means kept well, and fre- 
-quently caused great pain when used for hypodermic injections. 
A druggist in the sotith of Germany, Mr. Denzel, has endeav- 
ored to remedy this, at the request of Professor Saexinger, of 
Tubingen. He has isolated the active principles and experi- 
mented with them; and the experiments made in the clinic of 
Tubingen have proven that sclerotic acid was without any 
marked action upon the uterine muscles. Other experiments 
have proven the same, and also that neither ergotin, ecbolin, 
nor sclerotic acid, alone or any two combined, possessed the 
peculiar qualities of ergot which make it so valuable in obstetric 
practice. Hence, Mr. Denzel has prepared an extract which 
contains these three elements to their fullest extent, and the 
^combination has been used in the clinic of Tubingen. The 
extract is so prepared that the usual dose is retained. The 
prescriptions for internal use is one part of the extract to 
ninety of cinnamon water in tablespoon doses, and for hypo- 
dermic injections two drachms of the extract with two drachms 
of glycerine and four drachms of. water, injecting from one- 
ihalf to one syringeful at a time. 



134 SUGAR IN THE BLOOD. 

• 

Professor Saexinger, after carefully feeling his way, has 
given this extract in labor cases in considerably larger doses 
than he was wont to give ordinary ergot preparations, with 
good efifect and no bad results. He has seen no ill effects 
upon the child, and no evidence of the important, dreaded 
tetanus of the uterus. This preparation is well borne by the 
patient. In only a very tew cases was any unfavorable 
reaction observed; and in a few instances only was pain 
complained of at the point of injection; but this very soon 
disappeared, leaving no traces whatever. In one case only 
was there a slight infiltration noticed after hypodermic injec- 
tion, which, however, was rapidly absorbed. In none of the 
twenty- four cases were any of the usual ill consequences 
noticed. It has been used in the gynsecological clinics, as well 
as in cases where it was desirable to arouse uterine contractions. 
Thus in cases of metorrhagia and after abortion, and also in 
cases of chronic metritis, good results have generally followed, 
the cases being carefully observed, the size of the uterus, 
length and thickness being evidently diminished by the use of 
the remedy. This preparation, when dissolved in glycerine, 
may be kept for months without change. The advantages 
claimed are its stability and absence of ill effects, whether 
given by the mouth or subcutaneously, and especially that 
there is no danger of infiltration or formation of abscess at the 
point of injection when used hypodermically. 



THE PRESENCE, SOURCE AND SIGNIFICANCE OF SUGAR IN 

THE BLOOD. 



Seegen publishes (^PflUger'a Archiv, Band XXXIV, seite 388) 
an interestmg contribution to the much discussed question of 
the function of the liver in relation to carbohydrates. As \^ 
well known, Bernard and his followers regarded the liver as the 
sugar-making organ, and went so far as to maintain that the 
sugar thus formed was produced chiefly by the disruption of 
albuminous material. Pavy and others regard, in general, the 
liver as a sugar destroyer, by whose means the overloading of 
the blood with absorbed carbohydrate is prevented. Seegen 
lends his support to the older school. He shows that sugar 
formation in tne liver is a general physiological function shared 
by widely different groups of animals, herbivorous and carniv- 
orous. He finds, moreover, that the liver, even when excised, 
has the power of producing sugar from peptone. Numerous 
researches on dogs gave the following principal results: (1) 
Sugar is a normal constituent of the blood, but varies in its pro- 
portions from 0.1 per cent to 0.15 per cent. (2) The sugar con- 
tent of the blood in the right and left sides of the heart is the 
same. Differences between the proportion of sugar in arterial 



PERFORATION OF APPENDIX VERMIFORMIS. 135 

and venous blood are not constant but variable within narrow 
limits. The blood of the portal vein, however, nearly constantly 
contains less sugar than that of the carotid artery. (3) The 
blood which leaves the, liver contains double the quantity of 
sugar held by that entering it. The mean of thirteen experi- 
ments gave for blood of the portal vein, sugar 0.119 per cent; 
for the hepatic v5in, sugar 0.23 per cent. (4) The amount of 
sugar thus leaving the liver in the course of a day is very con- 
siderable. The amount produced by the dog's liver in twenty- 
four hours is calculated to vary from two hundred to more than 
four hundred grammes. (5) The blood-sugar is formed, at least 
in carnivorous animals, exclusively from albuminous bodies. 
(6) The sugar content of the blood rapidly diminishes when 
the liver is excluded. This sugar is used up in all the living 
tissues. — American Naturalist, January, 1885. 



PERFORATION OF APPENDIX VERMIFORMIS: TREATMENT. 



In the earlier cases of perforation of the appendix placed 
on record venesection seems to have been generally trusted to 
as the only means of cure, under the impression that the dis- 
ease was of a purely inflammatory character. It is scarcely 
necessary to say that such treatment proved of little benefit, 
inasmuch as the inflammation was the result of the introduc- 
tion into the serous sac of a decomposing, or at any rate of an 
irritating, material which no amount of blood-letting could 
remove. Its only effect was to lower the vital powers of the 
patient, and thus to diminish his chance of recovery by adhe- 
sion of the injured part to some of the neighboring organs. 
And other cases were treated by the use of drastic purgatives, 
on the supposition that the symptoms resulted from intestinal 
obstruction; but although in most cases the bowels were 
readily opened the fatal termination of the disease was not 
thereby obviated. On the contrary, the use of aperients 
proved to be so detrimental that they were entirely abandoned 
m this as in other forms of peritonitis. Of late years opium 
has been generally employed, but there has been no diminution 
in the mortality of the disease. I have prescribed it in every* 
case that has come under my notice for some years, either 
alone or with belladonna; it has always relieved the pain, 
lessened or subdued the vomiting, given sleep, and proved an 
immense comfort to the patient, but in no single case has it 
appeared to avert the fatal termination. 

Another plan of treatment has, however, been successfully 
adopted, namely, that of laying open the abscess formed 
around the perforation and allowing the pus to escape. The 
earliest case on record is one performed by Dr. Hancock, 
which ended in the recovery of the patient. Twenty years 
afberwani Dr. Parker, of New York, operated upon a case suo 



136 PERFORATION OF APPENDIX VERMIF0RMI8. 

cessfully, and Dr. Gordon Ruck, of New York, has collected 
thirteen cases of this operation, of which twelve recovered and 
only one died. I have twice advised this procedure. In the 
first cflse it was not performed until the patient was evidently 
sinking, but was found and evacuated; in the second, which 
was a very chronic one, the abscess was opened and recovery 
ensued. I have before mentioned that fluctuation can rarely 
be distinguished in abscesses of this kind, and out of ten 
recorded by Dr. Ruck it could be felt in only one, proving that 
there is no necessity to wait until this sign of abscess can be 
discovered. None of the above cases were operated on before 
the seventh day, and, with one exception, tne operation was 
not attempted until between the seventh and the fifteenth day ; 
but we have already seen that forty out of fifty-seven cases 
died during the first week of illness, so that if the rule should 
be followed, as has been hitherto laid down, of waiting until 
the pus is completely localized by adhesions, the operation will 
be restricted to a very small number of those who are attacked 
with this formidable malady. Theoretically it would seem to 
be much better if we could cut down upon the appendix as 
£Oon as the diagnosis was tolerably certain, tie it above the 
eeat of the perforation and remove from its neighborhood any 
concretion or decomposing material that might be the cause of 
irritation. The only objection that I can see to an early oper- 
ation is that adhesions to the neighboring organs might be 
prevented ; but when we reflect how very rarely the fortunate 
termination occurs, and how certainly death follows if it does 
not take pltice, we may, I think, dismiss the objection from our 
-consideration. But even when adhesion does result from per- 
foration the fatal issue is in most cases only postponed, for, as 
we have before shown, the adhesions are often torn asunder by 
some undue exertion of the abdominal muscles and fatal per- 
itonitis ensues. 

Two methods of operation have been pursued: In one an 
incision has been maae directly into the suppurating part and 
the pus at once evacuated ; in the other the incision nas only 
been carried down to the fascia, and either the pus has been 
allowed afterward to escape spontaneously or an aspirator has 
been passed into the most depending portion of the swelling 
and the contents thus evacuated. It is evident, however, that 
if an operation were performed at an early period the incision 
must be carried down directly to the injured part, for we can 
not suppose that pus would be formed and localized until many 
days after the perforation had taken place. 

The choice of the method of operation must of course be 
left to the discretion of the surgeon, and will probably require 
to be varied according to the circumstances of each case. Of 
one thing we may be quite certain, that no drugs are likely to 
be of much avil; for your common sense will tell tell you that 



NERVE COUNTERFEITS OP UTERINE DISEASES. 137 

when you have an irritating material suddenly introduced into 
a large serous sac the only chance of giving relief is to remove 
it, and thus put a stop to the original cause of the mischief. 
The office of the physician, therefore, will most likely become 
restricted to diagnosis, and it is only by carefully watching the 
first symptoms and the physical signs of the disease and by 
comparing them with those of other disorders that may sim- 
ulate it that we shall be able to arrive at such a correct judg- 
ment as may justify the employment of surgical measures at 
an early period of the .case. — London Lancet. 



NERVE COUNTERFEITS OF UTERINE DISEASES. 



The alcove was the subject of a lecture delivered by Dr. 
Wm. Goodell in the Hospital of the University of Pennsylvania, 
in which he remarked that: "The crying medical error of the 
day is, in my opinion, the mistaking of nerve disease lor womb 
disease. From this widespread delusion it has come to pass 
that no organ in the human body is so overtreated, and con- 
sequently so maltreated as the womb." He takes the ground 
that many cases which have been considered and treated as 
serious uterine diseases and cases of hysteria are simply, in 
fact, cases of nerve exhaustion or malnutrition of nerve centres. 

In his lecture which was puplished in full in the Medical 
News, December 6, 1884, he cites numerous cases with more or 
less detail, which illustrate the postion taken. He holds that 
in a vast majority of bed-ridden or sofa-ridden women, it is not 
so much any existing uterine trouble that puts them on their 
backs as it is nerve exhaustion from some nerve-shock. Neu- 
rasthenia he finds a most common disorder in our " over-taught, 
over-sensitive, and over-sedentary women." While reflex 
uterine symptoms are very common, he finds very seldom 
occasion for any local uterine treatment of such cases. 

Malnutrition of nerve-centres, leads to disturbances of 
nerve-action and to consequent irregular circulation of blood. 
Vaso-motor disturbances producing local ansemia or hypersemia, 
present different marked symptoms according to the organ 
affected, and according as hyperemia or ansemia predominates. 

In some cases there is a, concurrence of primary uterine 
disease with secondary nerve exhaustion, as in women worn 
out with frequent child-bearing or sexual excess. And on the 
other hand the disturbances of the circulation which are 
caused by the neurasthenia may beget local structural lesions. 
These of course may require local treatment. He asserts that 
"apart from these cases and those which clearly start from 
antecedent mischief to the reproductive apparatus, no good 
oomes from local treatment." 

As to the causes of this nerve exhaustion and hysteria, 
they are quite numerous, the most common ones being those 



138 DECISIONS ON MEDIOO-LEGAL MATTERS. 

which produce fret, worry or grief — mental wear and tear. 

The symptoms of nerve exhaustion includes most of those 
which have commonly been regarded as symptoms of uterine 
ailments, such as difficult locomotion, and a bearing down 
feeling, headache and backache, pain in the left ovary and 
spinal irritation, weariness and wakefulness, cold feet and an 
irritable bladder. The sense of fatigue is a remarkable one; 
the patient is always tired ; she wakes up tired, she passes the 
day tired, and she goes to bed tired/' Various other more 
characteristically " nervous " symptoms are frequent. 

For the treatment of these cases he depends upon the 
method for which we are indebted to Dr. S. Weir Mitchell. 
Five points are to be gained, namely, nutrition, sleep, rest of 
body and mind, freedom from pain, and an equable circulation. 

The patients are to be isolated and furnished with a good 
nurse. Iron is to be administered with malt and a rigid skim- 
med milk diet. In about a week they usually begin to crave 
solid ibod, which is then supplied in fixed rations at stated 
intervals and the patient is encouraged to drink between meals 
all the milk she will take. A bath is given every day. Massage 
and electricity are both used in this plan of treatment. The 
results attained are certainly wonderful when patients are so 
situated as to be able to carry out the treatment efficiently. 
One great difficulty is that many, perhaps a majority, of those 
who are suSering from nerve exhaustion are so situated that 
they cannot take such a course of treatment as that. 

Dr. Goodell is disposed to run to extremes in what he advo- 
cates. While all recognize the truth of the picture which he 
has drawn, there are other cases like those which he ha& 
described which so depend on uterine disease and can only be 
relieved by treating and curing that uterine disease. 



SOME RECENT DECISIONS ON MEDICO-LEGAL MATTERS. 



The records of the courts are full of cases of interest to phy- 
sicians, and a knowledge of them will often be of great value 
when called upon to appear as parties in actions or as expert 
witnesses in cases where other p)ersons are litigating. Of the 
most recent cases the following are of general interest: 

In an Indiana court a physician was charged with rape upon 
the person of a female patient, and the crime seemed to be 
proved, but the question arose whether the guilty party could 
* not escape the highest penalty because of a possible consent on 
her part. There was no evidence produced to warrant the claim 
of a consent. On this point the court said, '* If the jury be- 
lieved, as they might well have done under the evidence, that 
the appellant as a phvsician obtained possession and control of 
Rebecca's person, uncfer her mother's command, for the purpose 
of making a further examination of her alleged disease of the 



DECISIONS ON MBDICO-LEUAL MATTERS. 139 

womb, and not for the purpose of sexual intercourse, and that 
she never in fact gave her consent, through fraud or otherwise, 
to the sexual connection, then it seems to us that the appellant 
was lawfully convicted of the crime of rape." The verdict of 
the jury was therefore aflSrmed. 

In a Michigan case, the charter of a city obliged the common 
council to take measures for the preservation of the public 
health, and in carrying out this requirement a nurse was 
employed to attend a small-pox patient. A State law requires 
patients in the hospitals, if pecuniarily able, to pay for the ser- 
vices rendered them. The nurse faithfully attended to the case, 
and presented her bill to the city authorities who had hired 
her. They declined to pay, saying that she must sue tlie 
patient She refused to take this course, but brought suit 
against the city, and the courts sustained the action and obliged 
the city to pay. The opinion of the judges on appeal contains 
the following comment: "Individuals would not be willing to 
provide necessaries, and serve as nurses and assistants, at the 
instance of the public, if compelled to collect their pay of the 
patients or their relatives. The public is first and immediately 
responsible, and the intent of the statute is to enable the public 
to obtain reimbursement from those who ought to sustain the 
expense. The plaintiff hired herself to the city. She trusted 
the city, and no one else." 

In another Michigan case, a tramp was run over by a loco- 
motive in a railroad yard. A surgeon was summoned to help 
him, and sent a message to the superintendent and asked if he 
should do so. The superintendent answered, "Yes." Nothing 
was said about pay, and, in fact, the superintendent had no 
authority to bina the railway company to pay for surgical aid. 
Under these circumstances the surgeon sued the superintend- 
ent, under the theory that he was personally liable. The court 
held, however, that there was no contract between them of such 
a character as to make the superintendent liable. The effect of 
this decision is to exempt both the railway company and the 
superintendent from liability, and to oblige the surgeon to look 
to the tramp for compensation. As "tramps" usually are not 
men of means, the surgeon probably has been obliged to charge 
up his services to a general benevolence account. 

In a Kansas case, where physicians were called to give 
expert testimony, the judge charged the jury that such testi- 
mony "should be received and weighed with caution," and the 
question was whether this was a proper direction or not. On 
tnis point the court said, "The testimony of experts is to be 
considered like any other testimony; it is to be tried by the 
same tests and receive just as much weight and credit as the 
jury may deem it entitled to when viewed in connection with 
all the circumstances. We think this is probably as good a 
general rule as any that could be adopted. * * * While 



140 THE THIRD STAGE OF LABOR. 

many courts speak disparagingly of some kinds of expert testi- 
mony,— that with regard to handwriting, for instance,— yet 
we think that all courts hold that the testimony of competent 
medical experts is entitled to great respect and consideration. 
In the present case, we think the expert testimony of the phy- 
sicians and surgeons, who were in fact appointed by the court, 
and who made a personal and professional examination of the 
plaintiff's eyes, is entited to great consideration, and that the 
court below erred when it instructed the jury that such testi- 
mony should be * received and weighed with caution.'" 

In Germany the papers report a recent case where a physi- 
cian used the old methods of treating wounds, instead of the 
modern antiseptic dressings, and the patient died under cir- 
cumstances making it probable that if a different, treatment had 
been adopted his life would have been saved. The physician 
was sued for malpractice, and convicted, the court holding that 
** every practitioner should keep himself informed on the 
accomplished progress of science, and have an exact knowledge 
of modern systems of treatment. If these had been employed, 
the patient's life might have been saved: hence the liability for 
negligence." — Medical levies. 



ON THE THIRD STAGE OF LABOR. 



Dr. Simon Baruch read a paper with the above title, before 
the Medical Society of the County of New York, stating, as his 
reason for so doing, the variance of experienced obstetricians, 
and teachers, as to the proper method of conducting the third 
stage of labor. He then briefly referred {Medical Times) to the 
common devisions of labor into three stages, — the first, second, 
and third, which he accepted. In general terms, it might be 
said that, in proportion as labor advanced, was any deviation 
from the normal processes dangerous to the mother. With the 
advent of the third stage, the patient was ushered into a condi- 
tion in which the perils from abnormal processes culminated. 
Here attention to details which in themselves might seem insig- 
nificant was all-important for the preservation of the woman's 
health and preventing the destruction of human life. 

There were three methods of dealing with the placenta in 
vogue at present. The first was the ancient method of pure 
expectancy ; the second method consisted in active assistance 
in the removal of the placenta, and had as outgrowths the 
Dublin, and later the Crede, methods; the third, or eclectic, 
method occupied a middle ground between the extremes of 
•expectancy and energy of procedure. The author thought that 
in this department of medical art, as in all other departments, 
the golden mean was to be desired. He then quoted the views 
of various authorities, European and some American, with 
regard to the value of these several methods, particularly the 



THE THIRD STAGE OF LABOR. 141 

expectant and Crede's, and showed that many of those who 

Srofessed to practice Crede's method failed to do so in £Etct. 
tatistics of cases treated according to the expectant plan and the 
method practiced by Crede showed the advantages of the latter. 

It probably has been the experience of every obstetrician to 
have met with cases in which the placenta has been retained 
within the vagina, perhaps, for two hours without doing any 
harm, but it seems unreasonable to maintain that it was of any 
advantage to have the membranes retained for a length of time 
in this locality. The author had had but a single case in which 
the placenta had been unduly retained within the uterine 
cavity. He thought that many lives had been lost bv waiting 
for the uterus to expel the placenta of its own accord after an 
abnormal and a protracted labor. Every case should be treated 
according to its own peculiar surroundings. It could be of no 
advantage to leave a woman lying hour after hour in her own 
gore, in onxious suspense and great discomfort, waiting, with 
the idea that we are giving nature fair play for the expulsion of 
the placenta. The eclectic method seeks to make use of all the 
advantages possessed by Crede's, while omitting any of those 
measures which it might be well to discard. 

The author then referred to the twofold power of contraction 
possessed by the ut^us, the one being tonic and the other 
clonic. The latter alone constituted a true uterine pain. The 
former was illustrated during uterine involution after delivery. 
These clonic spasms for the expulsion of the placenta, or the 
third stage of labor, might be modified and rendered more or 
less abnormal by one or more unnatural conditions, as social 
surroundings, peculiarities in the second stage, the use of 
chloroform dunng labor, the tendency to haemorrhage. 

The author spoke of his* experience in midwifery among the 
colored people of the South as compared with that among the 
higher classes of the metropolis. In the woman of high social 
position many hours usually passed in what were called pre- 
pai'atorv pains, and by the time the second stage had been 
reached the nervous system was in a high state of reflex irri- 
tability, the expulsive contractions were not so steady and for- 
cible ; and here the author believed existed a cause of rupture 
of the perineum, as during the last four years of his obstetric 
practice, which had been m the city, he had seen more cases 
than during his fifteen years' previous practice in the South. 
In the negress he often found the placenta expelled into the 
vagina very soon after delivery of the child, while this was sel- 
dom the case in the city woman. In the latter class of cases 
haste in the third stage of labor was strictly to be avoided ; per- 
fect rest under proper surveillance was the true course. Inju- 
dicious friction or pressure would cause undue uterine irrita- 
bility and fail of the desired object, — ^namely, to obtain strong 
expulsive contraction. 



142 MIBCELLANEOUB ITEMS. 

The fact that chloroform had been given indicated that the 
uterine powers had been reduced; clonic contraction-power of 
the organ, which was necessary for the expulsion of the pla- 
centa, had been diminished. He would therefore recommend 
that the anaesthetic be diminished as the third stage was 
approached, and that Crede's method be aided by the Dublin 
method of tollowing the uterus down with the liand. When 
there was a tendency to hsemorrhage, Crede's method alone 
could not be relied upon : the uterus should be followed down 
as the child receded from its cavity, and should not be per- 
mitted to pass from under the hand. The method which he 
adopted, doubtless, was that practiced by many other physi- 
cians, consisting in gently stroking the uterus to stimulate it to 
contraction, of grasping the uterus with the outspread fingers, 
intensifying the strength of the contraction, and making down- 
ward pressure for the purpose of aiding in expelling the pla- 
centa out of the vagina or vulva. It might be necessary, in 
some cases in which the placenta was grasped by the neck of 
the uterus, to make traction upon the cord, or to insert the dis- 
infected fingers and make direct traction upon the placenta 
itself. It was his custom to place the two fingers of the right 
hand within the vulva, while the uterus was being compressed 
with the left hand, in order to guard ags^nst too forcible expul- 
sion and rupture of the membranes. The author regarded 
twisting of the membranes as objectionable, as it was liable to 
excite too energetic contraction and rupture of the membranes. 

MISCELLANEOUS ITEMS. 



A CORRESPONDENT to the Londxm Lancet asserts that honey is 
the best vehicle to disguise the bitter of quinine. 

A THREE HUNDRED THOUSAND DOLLAR legacy for the estab- 
lishment of a training school for nurses, under the control of 
the University of Pennsylvania, will soon b^ available. 

Dr. W. E. Witford, of New York, reports a case of a 
woman with four mammary glands, from all of which secretion 
took place during lactation. — New York Medical Record. 

Oil of Peppermint in Burns. — This drug is recommended 
as an external application in cases of burns. The burned sur- 
face is first cleansed and moistened with water, and then 
painted over with the oil, the effect being to relieve the pain 
very quickly. 

The Action of Salicylate of Soda upon the Uterus.— M. 
Balette relates {Journal de Medicine) the good effects of this 
drug indysmenorrhoea, by quieting the pain and facilitating the 



MISCELLANEOUS ITEMS. 143 

discharge of menstrual fluid. A dose of from four to six grams 
taken in three divisions often quiets the pain at the end of 
fifteen minutes or half an hour. 



Misplaced Kidney. — Dr. Miles F. Porter communicates, to 
the Journal of the American Medical Association the case of a boy 
eleven years old who died from injuries received by falling 
from a tree, where the postmortem revealed the right kidney 
in relation with the last two lumbar vertebrae and receiving its 
blood supply from the right common iliac artery. 

Aseptic Silk for Sutures. — Partsch (Deutsche Med.-ZeUv/ng) 
recommends that ordinarv silk be soaked for two days in a ten 
per cent, solution of ioaoform in ether, and then dried by 
wrapping it in blotting-paper. The advantages are said to be 
that it can be kept for a long time without deteriorating, and 
that it does not cause suppuration when left in a wound. — 
New York Medical Journal. 



Jaborandi in Erysipelas.— Dr. Sydney Thompson recom- 
mends the external use of jaborandi in erysipelas, and suggests 
the following formula: 

Fi. ex. jaborandi 25 parts. 

Tinct. opii, 

Glycerine... v.. aa 4 parts. 

The mixture to be painted over the affected surfaces every four 
hours. 



The Value of Expert Testimony. — Medical expert (on the 
witness stand) : " No, sir, it would have been impossible for 
the accused to quietly think out his plans for committing mur- 
der while walking on Broadway." Counsel for the defendant: 
** State why, doctor." Medical expert: "Because Broadway is 
the main artery of the city, and my professional skill teaches 
me tliat a quiet vein of thought on a main artery is paradox- 
ical and absurd." — Medical Record, 



Puerperal Fever in a Male. — The Revue de Medicale relates 
the case of a husband who nursed his wife who was ill with 
puerperal fever, and who was seized by an acute febrile affec- 
tion, characterized by chills, fever, albuminuria, tumefaction 
of spleen and liver, bronchial catarrh, hsematogene jaundice 
and multiple suppuration. There was no other source of 
infection but the wife, and therefore the case is deemed one of 
peurperal infection of the male. — Medical Review. 

A Method of Reducing Temperature. — Stephan says the 
application of ice-bags on the supra-clavicular regions duiing 
fever is followed by a marked reduction of the temperature. In 



144 MldCELLANEOUB ITEMS. 

Beveral cases of typhoid fever treated in this manner he was 
able to control the fever while the sensorium remained clear. 
The explanation offered is that many large and superficial 
veins are situated in the neck, and that by the direct applica- 
tion of heat to them the temperature of the blood is lowered 
rapidly. — New York Medical Journal. 

The Use of Cold in Labor. — Dr. Grognot {BvU. Qm. de 
Therap,) recommends the use of cold to produce and increase 
labor pains. The following are his conclusions: (1) The ap- 
plication of cold provokes marked contractions during labor. 
(2) They are normal in their effects. (3) This method is with- 
out daneer to the mother or child. (4) It can be used inde- 
Sendently and without instruments. (5) It can be employed 
uring all the stages of labor, for the expulsion of the foetus 
and also for the removal of the placenta. 



The Therapeutic Properties of Thyme. — Camperdon 
{Bull. Oen. de Iherwp.) concludes in a long article on this sub- 
ject with the following directions: (1) In therapeutical doses 
(three to fifteen grains) the essence of thyme causes mental 
excitement or stimulation; hence it is a valuable diffusible 
stimulent in depression following ansemia, in qpndition of 
collapse, etc. (2) It is an active diaphoretic and diuretic. (3) 
From its action upon the mucous surfaces it is to be recom- 
mended in catarrhal affections of the respiratory and genito- 
urinary tracts. (4) It is a prompt haemostatic. (5) Thyme 
possesses powerful antiseptic properties, and is well adapted 
for use in surgery. (6) It is recommended that the internal 
administration of the drug be supplemented by its employ- 
ment in the form of baths, fumigations and inhalations. 



Paralysis Following Hypodermic Injection of Ether. — 
Amozan {Qaz. hebd. de med, et de Chir.) contributes a long 
article on this subject, in which he cites a number of interesting 
cases. In several instances in which injections were made 
under the skin of the posterior aspect of the forearm, paralysis 
of the extensors was noted within a few minutes, tinder the 
use of the constant current the condition eventually disap- 
peared. In one case a deep injection into the thigh was 
immediately followed by darting pains, which persisted for* 
two weeks. The leg became livid and wasted away, and the 
reaction of degeneration was observed. The patient subse- 

Suently developed a trophic ulcer on the heel, and improved 
owly, though under treatment for a year. The writer thinks 
that (he phenomena described are really symptomatic of 
neuritis, which is due to the irritating action of the ether that 
has been deposited in the neighborhood of the nerve. 



THE 



PHYSICIAN m SURGEON 

A MONTHLY MAGAZINE, 
DEVOTED TO MEDICAL AND SURGICAL SCIENCE. 



Volume VII. APRIL, 1885. Number IV. 



ORIGINAL ARTICLES. 



erysipelas. 



BY ALFRED LAVBBTT, M. D., Philadelphia. PenKsylvania. 



The severe, cold of the passing winter has shown, if not 
theoretically, it has clearly demonstrated the fact clinically, 
that certain microziraes flourish best during coldest weather* 
Certain contagious diseases become malignant only during the 
midwinter months. As these diseases may exist the entire 
year, and sporadic cases appear at any time, it is evident that a 
low temperature is not necessary to produce them, but, as stated, 
some flourish best when the temperature is the lowest. This 
has made itself quite manifest this winter in the great frequency 
and virulence of erysipelatous afiections. Not for a long period 
has the various forms of erysipelas been so frequent or so- 
violent. 

Epidemics of the disease are mentioned by authors, but it is 
the cutaneous variety that is mentioned. While this form was 
unquestionably epidemic, it was the phlegmonous type that was 
most conspicuously prevalent during the long period of arctic 
weather that will make the past season memorable. The object 
of fliis article, however, is not to discuss the effects that meteor- 
ologic changes have upon disease, but to consider some points 
pertaining to erysipelas; an afiection which is very liable to> 
oecome a complication in all wounds and injuries, both in pri- 
vate and hospital practice Although, at all times, it is of very 
common occurrence, it is always an object of dreaa and a cause 



146 ERYSIPELAS. 

*of anxiety to the hospital surgeon; and even to a greater degree 
is iU generally feared by the obstetrician, since septic pueperal 
states have so frequently been traced to this source. 

Arguments are no longer made against the theory of its con- 
tagious character. Such denials as were once made now have 
no supporters among those who see most of the disease. When 
■a memoer of a family is attacked, it will not pass from one to 
another, as the more marked infectious diseases, but it is by no 
means uncommon to find several members of the same house- 
hold in turn taken with the disease. The foUowing from my 
•case-book will be sufficient to illustrate: 

In July I visited a lady in the suburbs of the city and 
found her suffering from a severe attack of erysipelas which 
•covered her arms, face, neck and chest. She thoueht she was 
poisoned while working among her tomato vines. The disease 
was without doubt erysipelas. The disease yielded to treat- 
ment but there existed a tendency to returning attacks. In the 
later part of August her daughter was attacked with the disease 
•on her face, starting from a slight abrasion on the side of the 
nose. In November the husband scratched his hand on a har- 
ness buckle and was attacked, and one week later a male servant 
was suffering with a swollen wrist and arm which proved to 
he phlegmonous erysipelas. 

The primary cause is due to a virus, but in what the con- 
tagium consists is not fully understood. Nor is it known to be 
the same in all varieties of the disease. Micrococci are found 
in the lymph spaces of the skin and have been successfully 
<;ultivated, and erysipelas produced from inoculations of the 
-cultivated germ. But the experiments resulted in producing 
zsimply the cutaneous variety of the disease. In some individ- 
uals the poison is aided by a predisposition to the disease. 
This constitutional tendency is so great in some persons that 
•erysipelatous inflammation follows every small abrasion and 
^vound. In most instances this ])redisposed condition is due to 
a morbid state of the system which has been produced by bad 
liabits, unhealthy surroundings, — causes which reduce the 
powers of resisting disease. All such agents that tend to break 
•Sown the general health are factors in producing that constitu- 
tional condition. It might be argued from this that the de- 
pressing effects of severe cold would account for the increased 
prevalence and severity of erysipelas during the past winter. 
Aside from the constitutional predisposition there must be a 
local predisposing cause, which consists in a cutaneous solution 
of continuity. There must be a wound, and wounds that from 
taome reason do not heal rapidly, but tend to fester and suppu- 
rate, are most frequently the starting point of erysipelas. 
Slight scratches and abrasions, caused by the teeth or claws of 
^animals, twigs and vines, or from eroded or composition metals. 
In four cases among weavers of a certain mill I attribute the 



ERYSIPELAS. 147 

'Caase to the coloring matter in the yam. The character of the 
wound has a great influence. Such lesions as tend to prevent 
the free escape of the inflammatory efi^usions, thus favoring 
decomposition of such discbarges, especially favor attacks of 
erysipelas. And, as indicated at the first, there are peculiar 
<;onditions of the atmosphere that favor the development of 
the disease. 

It is yet undetermined whether the local inflammation is 
the primary effect of the poison or whether the disease is con- 
stitutional, there being a period of incubation before either 
local or constitutional symptoms appear. Clinical observations 

Joint just as strongly m tavor of the one view as the other, 
f it DC due to a specific virus, acting as a blood poison, it 
must be considered a constitutional disease. Each view has 
its advocates, which gives rise to the opposed theories regarding 
treatment. In many cases it must be regarded as a purely 
local disease, the constitutional symptoms coming on after the 
local symptoms of the disease are well established. This is 

Sarticulariy true in sporadic cases. When the disease is epi- 
emic then the prodromic symptoms are well marked. 
Erysipelas is a general term and is made to cover a number 
of diseased processes, which may receive other names when 
the pathology is better understood. The classification of these 
forms are now made from the tissue involved, but in time they 
mt^ be found to be distinct diseases, depending upon wholly 
different producing causes. 

The symptoms of the cutaneous variety are so plain and 
definitelv marked that no one need err in the diagnosis, unless 
extremely careless, and when uncomplicated no serious results 
would come from a mistake. But such is not the case with the 
cMular variety. In this variety the skin is not attended with 
the intensely red discoloration and the burning pain of the 
cutaneous form of the disease. In the phlegmonous variety 
the local symptoms are insidious and delusive. The skin is 
not so red. nor the deepened color so uniform ; it may be dark 
or mottled, or changed but very little. It may not be atten()ed 
with much pain at first, but as the disease advances the pain 
will be greater, deep seated and throbbing. The swelling will 
be greater and, if limited to a joint, may be mistaken for rheu- 
matism. If the pain is not great, and in some cases it is not, 
the disease may advance until death is inevitable before the 
gravity of the case is discovered. The disease advances rap- 
idlv in broken constitutions. The hard, tense swelling soon 
feels soft and boggy. The serous infiltration is followed bv 
suppuration. The destructive violence is now under full head- 
way. The superficial and deep fascia, the sheaths of the mus- 
cles and vessels, tendons, ligaments and bone become involved. 
While these ravages are going on the deep-seated organs are 
being invaded. The pharynx and larynx oecome inflammed. 



148 HEALTH IN MICHIGAN. 

the tissues of the glottis become infiltrated with serum and 
pus, and the patient suddenly suffocates. The membrane of 
the brain may become involved, followed with coma and death. 
The system is overwhelmed by the poison, and the vital func- 
tions smothered under the depressing influences. 

In mild cases of the cutaneous form the simplest local 
treatment is often followed by the best results. It has been my 
custom of late years to envelope the affected parts in soft cotton 
wool, and administer effervescent drinks. In severe forms treat- 
ment must be directed to correct the depressing influences of 
the disease. In the severest cases I have found no better dress- 
ing or the need of other local treatment than the perfect encase- 
ment of the Dart in cotton. If the subcutaneous tissue becomes 
involved and abscesses form they must be boldly and i^eely 
opened. Slight punctures will not suffice; long, deep incisions 
must be made, the cavities thoroughly and frequently washed ^ 
the wounds carefully dressed with iodoform or carbolic gauze. 
Stimulating and supporting measures pushed vigorously. 



GENERAL CORRESPONDENCE. 



HEALTH IN MICHIGAN DURING FEBRUARY, 1885. 

Reports to the State Board of Health, at Lansing, by regular 
observers, in different parts of the State, compared' with report 
for preceding month show that pneumonia and inflammation of 
kidney increased, and that intermittent fever and tonsilitis 
decreased in prevalence during the month of February (four 
weeks ending February 28), 1885. 

Compared with the average for the month of February in 
the seven years, 1879 to 1885, erysipelas and neuralgia were 
more prevalent, and intermitterft fever, diphtheria, remittent 
fever, measles and scarlet fever were less prevalent, in February, 
1885. 

For the month of February, 1885, compared with the aver- 
age of corresponding months for the seven years 1879 to 1885, 
the temperature was considerably lower, the absolute humidity 
and the day and the night ozone were less, and the relative 
humidity was more. 

Including reports by regular observers and others, diph- 
theria was reported in Michigan in the month of February, 1885, 
at thirty-six places, namely— Albion, Alcona, Cadillac, Cedar . 
Springs, Dexter, Detroit, East Saginaw, Grand Rapids, Harris- 
ville, Holly, Hope township, Ishpeming, Ithaca, Ingham town- 
ship, Kalamazoo, Leelanaw, Lexington, Marquette, Maple Val* 
ley, Muskegon, Muskegon, Muskegon township, New Haven 
township, Nortn Star, Novi township. North Musk^on, Otsego, 
Oshtemo, Oshtemo township, Owasso, Pierson, Pierson town- 






ACTINOMYCOSIS IN MAN. 149 

ship, Port Crescent, South Bay City, Taylor, Winfield, Wyan- 
dotte; scarlet fever at twenty-eight pla,ce8 — Adrian, Albion, 
Berlin township, Burchville, Chester, Charlevoix, Detroit, Dover, 
Dundee, East Saginaw, East Tawas, Forest township, Grand 
Haven, Grand Rapids, Homer, Kalamazoo, Kearney, Leelanaw 
township, Lowell, Linden, Manistee, North Muskegon, Novi, 
Pentwater, Power township, Pierson, Sheridan township. South 
Haven, Vernon township; measles at East Saginaw, Detroit, 
Orand Rapids, Hopkins township, and small-pox at East Sag- 
inaw and south Boardman. Henry B. Baker, Secretary. 

Lansimo, Michigan, March 5, 1885. 



ORIGINAL TRANSLATIONS. 



GERMAN LITERATURE, 
TRAmuLTBD BY ALBERT E. JENKINS, ANN ARBOR, Michigan. 



A CONTRIBUTION TO THE KNOWLEDGE OF ACTINOMYCOSIS 

IN MAN. 



The case of actinomycosis in a man thirty-two ^ears old, 
which was first demonstrated before the surgical section of the 
fifty-sixth Natinforchersaminlung, and afterwards exhibited 
in the medical clinic at Freiburg, has since terminated fatally, 
the autopsy verifying the diagnosis. 

The commencement of the disease which ended in death 
after a sickness of two years, was characterized by frequently 
recurring peritonitic sysmptoms, and at last, three months 
before death, by two tumors which, developing first in the 
right, then in the left, side of the abdomen, perforated the 
iibdominal walls anteriorly. Shortly after a perforation of the 
intestine followed inducing aif evacuation through the abdom- 
inal fistula; later a communication with the bladder was 
opened, at length ending in the formation of a periproetic and 
prevertebral pnlegmone which led to a breach in the colon 
extending outwards towards the sacrum. 

The supposition that all the above mentioned occurrences 
were actinomycetic processes was substantiated by the presence 
in the secretions of the known granules with this peculiar 
microscopic characters. Death resulted from total exhaustion 
))y an intercurrent pneumonia. 

The postmortem section confirmed the belief that an inva- 
ision of the intestine had resulted. The principal extension of 
the disease was from the colon outwards, the malignant growth 
filowly but surely reaching out over the entire small pelvis and 
invading and enveloping the organs contained in it. The pel- 
yis, sacrum and lower lumbar vertebrse were, as the mascerated 
bones showed, entirely or partly changed to a fine spongy net- 



150 RHEUMATISM OF JOINTS— ^PHOBPHORUS. 

work, which in this case did not lack the formation of soft osteo- 
phytes. There were no metastatic changes in the other organs 
of the body, or any amyloid degenerations. 

In connection with this, Middeldorph reports one case 
which was only partially investigated. This manifested itself 
in the form of an abscess of the jaw which slowly formed after 
an ulcer of the mouth. A free incision into it was followed by 
a very moderate flow of pus in which were found a number of 
yellow granules the size of millet seeds. A microscopic exam- 
ination of them indicated leptothrix, and the author thinks, in 
accordance with the theory of Ponfick, that the actinomycetic 
granules are the descendants of certain forms of the schyzom^y- 
cetes which are closely related to the leptothrix-steptothrix 
group, but which, under certain influences have undergone 
peculiar modifications. In this case he 'referred them to the 
form of steptothrix fOrsten or a similar species. It is greatly to- 
be regrettea that he was unable to compare his specimens with 
the known fungi which closely simulate them in form. — DeuUsche 
Med. Wochenschrift, Numbers XV and XVI, 1884. 

ELECTRICITY IN CHRONIC RHEUMATISM OF THE JOINTS. 



In a dissertation at HaUe in 1884, Brettger cites fourteen 
cases of chronic rheumatism of the joints which were treated 
with galvanic current. The negative pole of the battery in the 
form of a metallic brush, was slowly moved away from the 
joint but in a line with it, frequently, however, resting it five to 
ten seconds in one place. The positive electrode, which was 
localized in the neighborhood, was a damp sponge. According 
to our author, a strong current (fifteen to thirty elements) is 
very painful, and if long ai>plied in one place, is liable to cause 
a slight ulceration, but with a weak current and the brush 
gently moved over the afiected parts, the sensation is very 
pleasant. Of the above fourteen cases, eleven were cured and 
two greatly relieved ; only one, and that a man with chronic 
rheumatism of the knee of the worst form and anchylosis of 
other joints, received no benefit. — CentrcJhlaU fUr die Oeaammt. 
Medicin, Number ll, 1886. 

PHOSPHORUS IN RACHITIS. 



According to the studies of Weiss, recently published in the 
Prager Med. Wochenschrift^ phosphorus is of little or no value in 
the treatment of rachitis. Eight children of from one to two 
years of age were subjected to a phosphoric medication for four 
months, with also an improvement in the diet. The results 
were very unfavorable, for only one was visibly improved, four 
were about the same as before treatment and three were per- 
ceptibly worse. — Prager Med. Woehenschrift^ Number XLV, 1884. 



TYPHOID FEVISR — DILATATION UF STOMACH. 151 

FRENCH LIIERATURE, 
Tbamblatbd bt B. J. WHLTBHBAD, A. R, Ann Abbob, Michioam. 



ERGOT IN TYPHOID FEVER. 



A writer in the -Union Medicate arrives at the following con- 
dueions in r^^rd to the use of ergot in typhoid fever : 

It is similar in its effects to sulphate of quinine and cold 
baths. 

It is especially useful in cases complicated with pulmonary^ 
or abdominal congestion, owing to its influence on sanguinary 
stasis and diarrhoea. 

It is antipyretic, its action being often very rapid. 

It diminishes the pulse-rate, and regulates the circulation-.. 

It rarely modifies ataxic and cerebro-spinal forms. 

It can be used during the menstural period without ill- 
effects. 

The dose must vary with the condition of the patient. In 
some cases from fifty to sixty-five grains must be given during 
twenty-four hours to obtain its therapeutic effect. M other 
times a much smaller quantity may cause derangement of th& 
circulation. 

The nausea sometimes caused by it need seldom occasion 
alarm; if it should continue too long the remedy may be given 
hypodermically. 

Bigot should be given in sma'l doses in order that its actioni 
may be closely watched. 

With children it acts very &vorabIy. 

DILATATION OF THE STOMACH IN INFANTS. 



Dr. J. Comby concludes a series of articles in the Archives^ 
Q^niraleB as follows: 

Dilatation of the stomach as occurring in the adult has been» 
carefully studied, especially since washing out the stomach has. 
become common, but the disease has been entirely neglected in 
cases of young children. Some have even denied its existence. 
And yet in the infant as in the adult the alimentary canal is^ 
the source of numerous disorders; it is the axis around which 
gravitates the pathology of the child, if we except congenital 
and hereditary diseases. 

A fact made evident by the author^s investigations is that 
dilatation of the stomach is slmost invariably accompanied by^ 
rachitis. 

The two diseases are not associated with each by chance^ 
but are related to each other as cause and effect; digestivo 
troubles preceding and preparing the way for rachitis. 

Derangement of digestion and dilatation of the stomach are: 
themselves the consequence of mal-nutrition. 



152 PECULIAR AFFECTION OF THE THIGH. 

The approach of the disease is insidious, and its progress 
like that of other chronic diseases. 

The physical signs of the trouble are an unnatural increase 
in the size of the abdomen, tympanism, and bruii de clapot(ige. 

The functional derangement manifests itself sometimes in 
the digestive apparatus (dyspepsia), sometimes in the nervous 
6vstem (convulsions, sleeplessness), sometimes in the skin^ 
(humors, rash), sometimes in the mucous membranes (bron- 
•chitis). 

The prognosis is unfavorable, because the dilatation may 
^continue to the second period of infancy, or even to adult life. 

In infants almost tne sole cause is insufficiency of food. 
The disease is most frequent in children that are bottle-fed, or 
that are weaned too soon, but may occur in those that nurse 
too frequently. 

The best preventive of the disease is to have the child 
ruckled by its mother or a nurse, and to regulate carefully the, 
amount of milk taken. 

The nursing bottle should be discarded. If the use of cow's 
tnilk is necessary, the child should be fed from a cup or a spoon. 

After the disease has become chronic the best remedy is 
proper diet — milk for very young children, dry food for those 
that are older. 



CLINICAL LECTURES. 



TENOTOMY FOR A PECULIAR AFFECTION OF THE TENSOR 
VAGINA FEMORIS MUSCLE, WITH ABSTRACT OF LECTURE. 



BY DONALD MACLEAN, M. D.. 
frofessor of Surgery and Clinical Surgery in the UniverBUy of Hicbigan. 

Reported by A. J. Hosxer, Class of '86. 



Among Other patients presented at the surgical clinique at 
the University Hospital, February 16, was one who had been 
before the class on several previous occasions. The case is one 
•of rare interest from the pathological principles involved, and 
unique as regards its effects, its diagnosis, and its treatment. 

Agusta K., aged forty years; occupation, machinist; entered 
the hospital January 5, 1885. The following history was then 
•obtained : 

About ten years ago he first felt a pain in his hip and along 
the outer and anterior portions of his thigh, which was corn- 
Dared to rheumatic pain or that occasioned by a sprain; but he 
nas no recollection of ever having sustained any injury. For 
the first five years this pain was not constant, and occurred 
only at irregular intervals. At such times a bunch or swelling 
would come in front of the hip-joint. Five years ago these 



PECULIAR AFFECTION OF THE THIGH. 153 

symptoms grew worse. The pain was more severe, and the 
periods of attack became longer and more frequent, until now 
they are constant, and very much worse at night He came to 
the hospital during October and entered the medical clinique, 
and for five weeks was under treatment for his general health, 
which had become impaired, and for sciatica. During that time 
sulphate of atropia and sulphate of morphia were injected into 
the enlargement every night. This gave him temporary relief 
but the pain returned during the interval, and when the injec- 
tions were discontinued, it was as severe as before. 

When he first appeared b^ore the class he was examined by 
Dr. Maclean and presented the following condition : A large 
swelling over the great trochanter, extending forward on the 
anterior part of the thigh. When the muscles were relaxed the 
mass was soft and indefinite in outline, and seemed to involve 
all the structures of this part of the thigh. But when the 
muscles were made tense by slightly flexing the limb and 
turning the knee out the tumor stood out very prominently. It 
was verv hard and solid. The edges were sharp and very 
olearly aefined. It extended from a short distance below the 
Anterior part of the crest of the ilium, nearly to the middle of 
the thigh. The contracted rectus femoris and sartorius muscles 
•could be plainly seen on the inner edge of the swelling, showing 
<5learlv that they were not involved. But it was very evident 
that the tumor involved the tensor vagina femoris. The pain, 
however, was not located in the anterior part of the thigh, but 
was felt behind the ereat trochanter and in the joint, and 
seemed quite independent of the swelling. All the tests were 
made for diagnosing hip-joint disease. Tapping the sole of the 
foot producea a slight pain in the jtant, but none of the other 
tests gave any evidence of ioint disease. The gluteal muscles 
were somewhat wasted, and the entire limb was atrophied. 
The patient did not have free normal muscular action. External 
rotation of the femur and eversion of the foot, were slightly 
ex^gerated, but internal rotation and inversion of the foot 
•GOuld not be perfornied. The patient stood with his limb in 
the former petition. Walking, or exercise of any sort aggra- 
vated the {>ain. During the night the leg could not be kept any 
length of time in a straight position. The pain would awaken 
him when he would have to take his hands and **draw the leg 
up," which would partially relieve the pain. 

The disease was regarded by Professor Maclean iis some- 
thing very peculiar and remarkable. It was very difficult to 
tell what the trouble was. It was very evident that there was 
no disease of the joint. He presented none of the characteristic 
symptoms. The very slow progressive character alone was 
sufficient to exclude that supposition. He had entered the 
hospital to receive treatment for sciatica. But it is a very 
cmsafe plan to allow the patient to make his own diaignosis. 



154 PECULIAR AFnCTiON OF THE THIOH. 

m 

While the pain and the tumor seem to be two entirely 8e|>arate> 
troubles, they evidently have a close relation. The character 
of the tumor is exceedingly peculiar. It seems to be entirely 
confined to the tensor vagina femoris muscle, and to be nothing 
more than a hypertrophy of the muscle itself. There is no* 
vieable cause for this hypertrophy, and it is difficult to see why 
that condition should produce so profound an effect upon the 
nerves and nutrition or the whole limb. Before any operative 
measures are used it will be necessary to have a more definite- 
knowledge regarding the cause of the trouble. 

There is no doubt that this man's occupation has been in 
some way the original cause. A certain position of the 1^ pro- 
duced an unnatural constant strain upon the muscle or fascia. 
This i)roved an irritation sufficient to produce a change in the- 
nutrition of the muscle and caused a state of irritability which 
now not only tends to perpetuate itself but to aggravate the con- 
dition. When the healthy inervation of a part is once over- 
thrown, the deranged nervous influence will in a short time 
become a constant source of irritation of itself, not only to the 
parts originally involved, but to associated parts either near or 
remote. I think we have this principle clearly illustrated in 
this case. Just how to remedy tne changed condition of affairs 
is not possible now to determine. It may be the muscle thatis 
at fault or it may be the nerve supplying all the parts involved,, 
and this muscle being the first is the part most influenced. 

Two days later the patient was re-examined, when it was 
thought that some benent might bo obtained by dividing some 
of the deep fascia of the thigh, as the thick external portion 
into which the tensor muscle inserted seemed to be unusually 
tight and resisting, particularly when the muscle was con- 
tracted. This portion of the fascia was then divided subcu- 
taneously. The result of the operation was not satisfactory. 
The pain was not relieved and tne patient's rest continued to- 
be disturbed by the contractions of the muscle. One week 
following the first operation a second was made. This time the 
fascia was much more extensively divided. The operation was- 
done without an anaesthetic in order that the result might be 
tested. Additional portions of the fascia were cut until the- 
patient had no power to contract the muscle. When this point 
was reached the movements of the leg were made much freer, 
the femur could be rotated inwards, and the foot inverted with- 
out difficulty. The edges of the fascia separated widely, and a^ 
large gape could be noticed through the integument. This 
operatiou was followed by greater disturbances than the former. 
In a few days the leg in the region of the operation was painful,, 
swollen and inflamed. He was ordered to keep perfectly quiet, 
the part was poulticed and every precaution taken to prevent 
the mflammation and the suppuration extending along the 
sheaths of the muscles. The leg was firmly bandaged, and all fluid 



NOTES OF TWO 1NTERE8TIKG GASES. 155 

•arefally and thoroughly washed out twice daily. None of the 
old pain returned, the swelling soon disappeared and the patient 
has oeen able to sleep all night since the operation, with the leg 
extended. At one time all discharge stopped and the wound 
was nearly healed, but a sudden severe change in the weather 
caused a httle flairing up in the parts, but that is now rapidly 
subsiding and the patient is about ready to leave the hospital^ 
relieved of all his former pain, deformity and distress, — ^in 
fact, cured. . 

HOSPITAL REPORTS. 



MICHIGAN STATE HOSPITAL. 



UNDER PROFBSSOa A. B. BALMBR, M. D.. 
ProftMor of PracUoe and Patholoffy, and of CUnioal Medicine, in the Unirenlty o* 

Michigan. 
J. H. BAND, CuiciCAi. Clbsk. 



NOTES OF TWO INTERESTING CASES. 



DIABETB8 MELUTI8. 

John M., Petrolia, Ontario, aged thirty-two years; farmer; 
anmarried. Admitted February 11, 1885. 

Hutory. — Family record eood. When sixteen years old had 
an attack of inflammation of the bowels, which lasted about six 
weeks. The following year had a second attack, but made a 
good recovery. Since second attack health continued good 
until two years ago, when plowing, he was struck a severe blow 
on the left side of the thorax with the handle of the blow. The 
effects of the blow passed off, but in two weeks he began to 
experience a constant and excessive thirst, with frequent desire 
to pass urine. The quantity of urine voided was verv large. 
These symptoms increased rapidly, and becoming alarmed, 
medical advise was sought. His physician examined his urine 
and found a large amount of sugar present. Treatment was 
immediately begun, bdng principally dietary. He improved ; 
the quantity of urine was considerably diminished. About one 
week ago he noticed swelling of the lower extremities, which 
has increased. Habits: he uses liquor moderately, and both 
chews and smokes tobacco to excess. 

Family History. — His father died of consumption, and his 
mother from renal or heart trouble. The prominent symptom 
of her diseose was dropsy. 

PresevU Oondition. — Appetite good; bowels slightly consti- 
pated; tongue coated with yellow fur; pulse, 96; temperature, 
98°; urine for twelve hours, 3,525 cubic centimeters; reaction,, 
neutral; specific gravity, 1,038; large amount of sugar present 

Diagnom. — Diabetes mellitis. 



156 NOTES OV TWO INTERESTING CASES. 

JVeatmenL — The patient was placed upon the treatment 

recommended by Professor Austin Flint: 

B. Arsenid bromidi HfRnJ* 

8. Three times a day very largely diluted. 

Also take a warm bath every second day and protect the 
person with warm clothing. 

February 18: Urine for twelve hours, 3,750 cubic centi- 
meters; specific gravity, 1,044 ; reaction, acid. The bromide of 
arsenic ordered to be gradually increased until four drop doses 
are taken. Diet, which previously had been liberal, was now 
restricted as much as possible to anti-diabetic fare. 

February 21 : The patient states that he is passing less urine, 
a.nd is not compelled to get ud during the night to empty his 
bladder. Same treatment to be continued, but the size of the 
doses gradually increased. 

February 25: A marked change in the q^uantity and char- 
acter of the urine. The general appearance oi the patient much 
improved. He looks brighter. Unpleasant head symptoms not 
so severe. Urine for twelve hours, 900 cubic centimeters; acid ; 
specific gravity, 1,035. A feeble test showing but a trace of 
sugar. 

February 28: Urine for twelve hours, 1,181 cubic centi- 
meters; acid; specific gravity, 1,042. Test gives but a trace of 
sugar. He continues cheerful and feels well and strong. Diet 
•confined chiefly to eges and meat. 

March 4: Urine for eight hours, 1,000 cubic centimeters; 
acid; specific gravity, 1,045. Quantity of sugar increased. Not 
feeling so strong and well. Appetite not so good. Bowels 
slightly constipated. Continue treatment with the addition of a 
laxative pill occasionally. Left hospital to continue treatment 
■at home. 

March 18: Received letter from patient. Continues to 
improve and feels well. Urine for twelve hours, 1,200 cubic 
•centimeters; acid; quantity of sugar, 12.4 grams. 

Note. — When patient entered hospital he was passing daily, 
•on an ^average, about one hundred grams of sugar, and seven 
thousand cubic centimeters of urine. As he continues to 
improve under the treatment it has been ordered continued. 

congestion of spinal cord. 

W. R., Montague, Michigan, aged forty years; married ; 
lumberman. Admitted October 1, 1884. 

History. ^General health had been good until last March. 
At this time he was suddenly taken with pain in lumbar region 
of the spine. This grew rapidly worse until evening when a 
physician was called. Typhoid fever was diagnosed and he 
was treated for that disease. The pain was not improved but 
grew worse. 

Present Ocmdition, — The patient now has headache constantly. 
The pain in the back continues, and at times it increases m 



N0TK8 OF TWO INTERESTING CASES. 167 

• 

severity, and extends to his l^s and chest During the periods 
when the pain is the most severe his feet are cold. There are 
creeping and ''queer" sensations in the legs. Tendon reflex 
is present but much diminished. A sharp blow on the patella 
tendon causes some convulsive movements of the muscles of 
the thigh. At times a pain radiates from the heart down through 
the stomach and intestines. Appetite good; bowels regular. 
Analysis of urine: Six hundred and twenty-five cubic centi- 
meters; color, red; odor, normal; heavy aepoeit of urates; 
number of crystals of oxylate of lime. 

Diagnosia, — Congestion of spinal cord. 

Treatment. — 

B. Potassii iodidi gr. viij. 

Potassii bromidi gr. viij. 

Ext. ergotse, fl 388. 

M. Sig. Take three times a day between meals. 

Dry cups were ordered to be applied over tender regions of 
the spine. Current of electricity, used by applying one elec- 
trode at nape of the neck and the other passed along whole 
length of spine. 

October 25: Medicine and cupping has been kept up. Four 
cups were applied in lumbar region of the spine twice daily. 
The current was discontinued. It produced uncomfortable 
effects, and seemed to aggravate the symptoms. After stopping 
the current the patient gradually improved. Patient was per- 
mitted to go home with instructions to continue treatment. 

November 5: Returned to hospital. Marked improvement. 
Same treatment continued. 

February .11: Returned much improved. Sensations in 
limbs disappeared. Pain in the back greatly diminished, and 
movements more free. Pain in the chest continues but not so 
severe and does not extend over abdomen. Former treatment 
stopped. The following ordered: 

B. Sodii salicylici gr. xv. 

Dose: Taken three times a day. 
Also, 

B. Potassii bromidi gr. viij. 

Dose : Taken between meals. 

March 10: Greatly improved. Back becoming strong. Move- 
ments do not occasion pain. Occasional pain in the chest. 
Patient dismissed, but orciered to continue taking last prescrip- 
tions, for a short period. 

Note. — When received into the hospital the patient was not 
able to stoop over or bend his spine in any direction. He had 
to be assisted in taking off and putting on his clothing. Sit- 
ting down and rising up, were inovements accompani^ with 
severe pain. On leaving all movements of the trunk were free 
and painless. 



158 toATE MEDICAL SOCIETY. 

EDITORIAL PERISCOPE. 



STATE MEDICAL SOCIETY. 



The twentieth meeting of the Miohiean State Medical Society 
will be held in Port Huron, Wednesday and Thursday, June 
10 and 11, 1885. 

At this late day in the history of scientific societies and 
associations, it would seem unnecessary to present arguments 
in their favor or regarding their usefulness. But from the 
small percentage of the physicians that attend their professional 
societies, one might be led to the conclusioa that the great 
maiority of the profession do not look upon them with favor, or 
at least do not regard them essential to, or tending to promote, 
the best interests of the profession. When judgment, nowever, 
is made from an observation of those who do attend, these 
meetings must be refl:arded both attractive and instructive, for 
at each meeting, with slight varying exceptions, the same faces 
are seen and the same voices heard. These are of the leading 
and foremost men in the profession. If our eminent teachers, 
and the prominent practitioners are interested and benefitted, 
they.must certainly prove equally so to every member of the 
profession. These meetings are necessary to increase the power 
and influence of the profession, and it is each physician's duty 
to do that which tends toward that end. 



There is a burning disgrace resting upon the profession of 
the great State of Michigan. Fully one thousand two hundred 
self-confessed quacks are registered, and thereby duly author- 
ized to practice medicine under the laws of the state. This 
one thousand two hundred publicly confess that they had no 
professional preparation before they began practice, and have 
received none since, excepting that which they have acquired 
at the expense and suffering of a deluded and unprotected 
people. In this state, admired by the civilized world for its 
grand free system of public education, there are one thousand 
two hundred persons engaged in the practice of a learned pro- 
fession, who acknowledge themselves devoid of education both 
general and professional. 

The qualified portion of that profession allow and beyond a 
mental protest sanction it, and then wonder why their profession 
is not more highly esteemed and respected. Not until this 
canker is removed will the profession take the high rank it 
enjoys in other states and countries. This result cannot be 
accomplished by a few, — it must be done through united action 
of an organized body. The State Medical Society is the organi- 
zation that can accomplish this result if its whole influence is 
once brought fully into use. There is no hope that there will be 



THE INDEX MEDICUB. 1S9 

•any saccessful legislation on the subject this year. To have action 
in two years, work must be begun now. To purge this state of 
its one thousand two hundred professional vandals and para- 
sites, is a work well worth the laoor and influence of every and 
all respectable physicians. The performance of this long 
n^lected dutv the profession owes to itself and to the people 
who confidingly place themselves under its care, but who are 
not able to discriminate between medical vandalism and the 
practice of true physic. 

The life of a medical societv consists in every person taking 
an active part. A member's duty does not stop with such aid 
as his mere attendance ma^ give, but it includes the unveiling 
of those methods and practices that are created under the tension 
of emergencies and ripened by after reflections and experience. 
Let a retrospect be taken and such thought and practice that 
have stood the test and such expediencies as have tided over 
dangers and uncertainties, be noted down and read for the 
benefit of others. Let the titles of such articles, or better, the 
papers themselves, be sent to the chairman of the proper com- 
mittee. The chairman of the several committees are as follows : 

Dr. V. G. Vaughan, Ann Arbor, State Sanitation; Dr. E. P. 
Ohristian, Wyandotte, Obstetrics; Dr. A. B. Palmer, Ann 
Arbor, Committee on Temperance Question — (W. C. T. U.) ; 
Dr. C. J. Lundy, Detroit, Ophthalmology and Otologv ; Dr. H. 
B. Shank, Lansing, Necrology ; Dr. D. W. C. Wade, Holly, 
Practice of Medicine ; Dr. J. T. Main, Jackson, Surgery. 



THE INDEX MEDICUS. 



We with pleasure call the attention of our readers to the fol- 
lowing circular, announcing that Drs. Billings and Fletcher, 
will resume the publication of the Index Medicus, Mr. George 
S. Davis, of Detroit, Michigan, assumes the management and 
pecuniary risk. The profession is to be congratulated upon the 
revival of this valuable publication. To the student and the 
writer it is an inestimable aid, as it economizes time and labor 
to have at hand a full and reliable reference. The Index was 
the reference book of the medical world, and from it there is 
due the financial support that will insure its success : 

** We take pleasure in announcing that Mr. Geo. S. Davis, of 
Detroit, has undertaken to continue the publication of the Index 
Medicus^ on the same general plan, and with the same regard to 
typographical accuracy and finish, as heretofore. 

"On account of the <lelay required to perfect this arrange- 
men /, the first number of the journal for the current year will 
comprise the literature of January, February, and March, after 
which it will appear monthly, as usual. 

''At the end of the year, in addition to the usual annual 



160 EFFECTS AND USES OF HYDRASTIS. 

index of names, subscribers will be Aimished with an index of 
subjects to the volume. 

^* So many expressions of regret and urgent remonstrances in 
regard to the threatened discontinuance of the Index Medicus 
have been received, that we think we may venture to congrat- 
ulate the profession on Mr. Davis's public-spirited determina- 
tion to carry on the enterprise in spite of the fact Uiat thus far 
it has not been pecuniarilv remunerative. 

^' It is requested that all exchanges and books and pamph- 
lets for notice be sent to the Index Medicua, Washington, District 
of Columbia. 

*' John S. Billings, M. D. 
'' Robert Fletcher, D. D. 

" Wabhinoton, DiSTBicr or Columbii, March 4. 1885." 



THE PHYSIOLOGICAL EFFECTS AND THERAPEUTICAL USES 

OF HYDRASTIS. 



The entire space of the March number of Dribga and Medi- 
cines of North America is devoted to a continuation of a treatise 
on *' Hydrastis Canadensis," which was begun in the January 
number. It contains an article by Professor Robert Bartholow, 
on the medical properties of hydrastis. This article is the 
result of physiological investigation and laboratory research ^ 
made upon inferior animals and containing much that is val- 
uable. The following quotations are made: 

• " But little attention has heretofore been givt^n to the phy- 
siological actions of hydrastis. It is true Schatz, Felluer, 
Sclavatinsky, and some others have made some studies, but 
their results differ so widely from those herein detailed that it 
may be questioned whether they operated with sufficiently 
good specimens of the drug. The alkaloid hydrastine with 
which the following experiments were made was sent to me 
by Professor J. U. Lloyd, of Cincinnati, who is, I hope I may 
be permitted to say, unimpeachable authority. As hydrastine 
is quite insoluble, a solution of the hydrochlorate was prepared 
for me by Messrs. John Wyeth & Brother, which contained 
thirty-three per cent, of the salt. The effects of the alkaloid 
were compared with those of the fluid extract. As the actions 
of hydrastis consist of the sum of the effects of its active con- 
stituents, it is necessary to know how far each contributes to 
the results. It was soon ascertained that the alkaloid hydras- 
tine is the true active principle — for the very characteristic 
effects of this were simply repeated by sufficient doses of the 
fluid extract. The latter is, as might be expected, slower in 
action, but in respect to the manner of action, there was be- 
tween them no appreciable difference. Three grains of the 
hydrochlorate caused the death of a frog in u>\xr minutes, 
whilst forty minims of t^e fluid extract proved fatal in twelve 



EFFECTS AND USES OF HYDRASTIS. 161 

minutes, the mode and character of the action being the same. 
The results in rabbits were corresponding. In general terms^ 
the effects of hydratis are those of hydrastine in both classea of 
animals, but minute differences may hereafter be detected on 
closer examination." 

From experiments made upon the frog and rabbit, with a 
solution of the hydrochlorate, hydrastine was found to belong 
to the group of excito-motor agents. 

" It heightens perception, the cutaneous excitability, and the 
reflex functions, and it causes death by tetanic fixation of the^ 
respiratory muscles." 

It was also shown that the convulsions and spasms were 
caused by the action of the drug upon the brain and cord^ 
and were not peripheral ; and that the irritability of the per- 
ipheral nerves and muscles was exhausted. When applied to 
a freshly removed heart, or one en situ, it rapidly loses its elec- 
tric excitability, and soon a complete arrest of movements 
takes place in diastole. 

"Tne pneumogastrics being divided, ten minims of the soFu^ 
tion are injected into the abdominal cavity. The heart is acted 
on more slowly, and its excitability to stimulation, electrical 
and mechanical, although much feebler tiian normal, still per-^ 
sists. On excitation of the peripheral end, the heart is rather 
lazily arrested. In the previous experiments, the heart iumEis- 
turbned in its anatomical relations, it was found that the excT^ 
ability of the vagus, just before the cessation of respiration, was 
entirely destroyed, and at the stoppage of the heart's move- 
ments, its muscular irritability was lost. Prom these experi- 
ments we learn that hydrastine acts both on the inhibitory and 
motor apparatus, destroying their power of response to excita- 
tion, but the former function yields later, or after the latter;. 
To determine more preciseljr the nature of the action exeoted 
on the cardiac motor and inhibiting apparatus, the vagus was 
first paralyzed by atropine, and then the usual aose of hydras- 
tine administered. The increased movement caused by atro^ 
pine was soon lessened by hydrastine, and the heart, after the 
cessation of the respiratory movements, was ultimately arrested 
in the diastole, the cavities fully distended as before described. 
The effect of the atropine was now exhibited in the preservation 
of the irritability of the heart muscle. In the experiments beftrft 
detailed, it was found that hydrastine destroyea the irritabilfl^p^ 
of the heart muscle, but when atropine was administered, the 
response to mechanical and electrical irritation was retained^' 

The action of hydrastine causes a lowering of the bloods 
pressure. Chloral was found to antagonize to a large extent the 
increased reflex excitability and the tonic convulsions caused 
by the drug, and Dr. Bartholow thinks that probably the 
antagonism will be found as extensive in range as between 
chloral and strychnine. 

K 



162 EFFECTS AND USES OF HYDRASTIS. 

"A remarkable correspondence can be traced between the 
actions of strychnine and hydrastine, but the ^ower of the 
former seems to be the greater whilst in extent of action the 
latter seems far more. Both exalt the reflex function of the 
cord ; both induce tetanic convusions, and both cause death by 
arrest of respiratory movements in a tonic spasm. Hydrastine 
more effectually affects the peripheral nerves and muscles, and 
to a much greater extent impairs the contractility of the car- 
diac muscle." 

" The Therapeutical Applications of Hydrastis. — As the results 
obtained from the administration of hydrastis constitute the sum 
of the actions of its several constituents, it may be best to con- 
sider the powers of the active principles separately, before treat- 
ing of the effects of the drug as a whole. The plants contain- 
ing berberine are, as a rule, members of the tonic and reconstit- 
uent group. Hydrastine being peculiar to hydrastis, much of 
the effect produced by this agent must be due to the presence of 
this principle. Prescribed alone, hydrastine has been supposed 
to have the effects of a tonic, antiperiodic, and to some extent, 
alterant — a term used to signify the power to promote the waste 
and excretion of morbific materials. The physiological study 
of hydrastine, as made by Schatz, Felluer, Sclavatinsky, and 
others, has not contributed to the subject of its therapeutical 
power, although it forms a groundwork for the therapy of the 
future. If, however, the physiological actions as detailed in 
this paper be confirmed by subsequent researches, quite a new 
phase will be given to its therapeutical applications. As the 
fluid extract contains all the constituents of hydrastis, it is the 
most concentrated form available for administration and, there- 
fore, will be the best preparation for procuring the effects of the 
remedy as a whole, whether given by the stomach or applied 
externally. 

^^ Hydrastis in ChstrO'Intestinal Disorders. — As a stomachic 
tonic, when the condition of the stomach is that of debility, as 
we find it in atonic dyspepsia, so called, and in convalescence 
from acute diseases, hydrastis serves a useful purpose. In com- 
mon with the bitters, it stimulates appetite and increases the 
secretion of the gastric glands. Disposing thus of an increased 
supply of aliment, the constructive metamorphosis is promoted. 
For this purpose, it is best to administer ten to twenty drops 
of the fluid extract a few minutes before meals. Both tne 
alkaloids of hydrastis, exerting an inhibitory influence on fer- 
mentation, the fluid extract can be given with excellent effects 
in cases of catarrh of the stomach accompanied with fermenta- 
tive changes in certain foods, whether or no, the Sarcina Ventric- 
uLi be present. The result of the action will be more perma- 
nent than the above remark implies, seeing that this remedy 
can modify, if not remove, that alteration of the mucous mem- 
brane which is accompanied by an outpouring of pathological 



EFFECTS AND USES OF HYDRASTIS. 163 

mucus. To effect this purpose it were better to administer the 
fluid extract, two or three hours after meals, and the dose 
should range from fifteen to thirty minims. As a tonic and 
reconstituent in the classes of cases above mentioned, quinine 
is now largely used: it is quite certain that hydrastis can be 
substituted for the most part with advantage. The experiments 
of Rutherford have confirmed the belief, founded on empirical 
observations, that hydrastis is an hepatic stimulant, altnough 
not one of the most active. As he operated with 'hydrastin' 
so-called, which consists for the most part of berberine, it is 
probable that the results which he obtained are not equalled by 
those produced by the exhibition of the fluid extract. Hydras- 
tis has been found useful in gastro-duodenal catarrh, associated 
with catarrh of the bile ducts — a morbid condition in which 
the output of bile is lessened by the mechanical obstruction, 
and the intestinal digestion is impaired in consequence of the 
insufficient supply of bile, the fermentative changes set up by 
the mucus which plays the part of a ferment, and the conse- 
quent absorption of imperfectly prepared materials. In this 
state of things we find the true explanation of some cases of 
jaundice, of most cases of ^biliousness,' and the initial changes 
of lithffimia. The gastro-duodenal catarrh of chronic alcohol- 
ism is a condition in which the use of hydrastis has a decid- 
edly beneficial effect, and the improvement in the digestion 
has seemed to lessen the appetite for alcoholic stimulants. 
This statement, made by several observers, has been rather sar- 
castically commented on by the authors of the National Dis- 
pensatory, who are, however, pessimistic if not nihilistic in 
their therapeutical conceptions. The new facts, demonstrating 
the effects of hydrastine as a spinal stimulant, are additionsd 
reasons for supposing it to be possessed of the powers claimed. 
For the relief of the intestinal troubles above mentioned, the 
fluid extract of hydrastis should be given in the interval 
between the meals, and the dose should be larger (one-haJf to 
one drachm) than in the case of the corresponding stomachal 
troubles. As an antipyretic and antiperiodic, the alkaloid — 
hydrastine— has had no adequate clinical study. Twelve years 
ago, I made some experimental trials at .the Hospital of the 
Good Samaritan, in Cincinnati, in seven cases of tertian inter- 
mittent. White hydrastine in crystals was furnished me by 
Professor E. S. Wayne, M. D., of Cincinnati, the well-known 
chemist and pharmacologist. Two of the cases were recent, 
uncomplicated, and but a few paroxysms had occurred. 
Twenty grains of hydrastine, administered in three doses, in 
anticipation of the seizure, merely modified its violence, but did 
not prevent it in either case. The second attempt proved suc- 
cessful. Three of the cases more chronic in character required 
sixty, sixty-five and eighty grains respectively. The two remain- 
ing proved still more rebellious, and the patients becoming 



164 SUBPERIOSTEAL METHOD OF AMPUTATION. 

uneasy, I was forced to resort to quinine. The supply of pure 
hydrastine was not sufficient to carry on further experiments^ 
and a suitable opportunity to resume the investigation not 
occurring, I have no further clinical experience in this direction 
to report. Nevertheless, these trials, wnilst not numerous, are- 
at least significant. They indicate the possession of real anti- 
periodic power, inferior to quinine, it is true, but apparently 
inferior onlv to the great antiperiodic. Since that time, the 
chemist's skill has produced by synthesis various products 
approaching in composition closely to quinine, and possessed 
of powers very similar but still inferior. It may be that under 
these circumstances, hydrastine will never rival quinine or its 
analogues, but the powers which it is now shown to possess 
may require a different statement hereafter. 

^^ Topical Applicaiiona. — For local use, the best mode of 
applying hydrastis is in the form of the fluid extract, which 
may be employed undiluted or diluted with glycerine. It& 
staining power is an objection, since the color which it imparts 
to cotton cloth, if not permanent, is at least not readily washed 
out. This fact suggests the possibility of using this pigment or 
coloring matter as a dye stuff. The fluid extract of hydrastis 
is an excellent topical application in cases of catarrhal inflam- 
mation of the mucous membranes. In nasal, faucial, urethral 
and vaginal catarrh, and in otorrhoea and conjunctivitis, there 
can be no doubt of its good effects. It may be applied freely 
in the undiluted state without fear of injury, if no good be 
accomplished by it. It has proved to be a very efficient injec- 
tion in gonorrhoea, more especially after the acuter symptoms 
have subsided. For this purpose it may be diluted with 
glycerine or mucilage, or both, to the required extent. Form- 
erly when I used to see these cases in considerable numbers, 
I found it a capital application in cervicitis. I had, also excel- 
lent results in such cases and in gonorrhoea, from * hydrastine ' 
suspended in mucilage. 

^^To express a final judgement as to its therapeutical value, 
my conviction is that hydrastis is a useful remedy, and well 
deserves a trial in the various conditions in which it is recom- 
mended above." 

"SUBPERIOSTEAL" METHOD OF AMPUTATION. 



While surgeons continue to differ as to the method employed 
in amputations, the comparative value of these methods is, it is 
safe to say, properly appreciated. The differences in practice 
can be easily explained upon the broad argument, tnat the 
application of methods differ, just as minds differ in thought 
ana deductions. While the above is true of the more common 
and established measures, the Lancet ai^ues that the value of 
the so-called '^ subperiosteal " method ofamputation has, how- 



SUBPERIOSTEAL METHOD OF AMPUTATION. 165 

€ver, excited far less attention in England than on the Contin- 
ent, or than it really merits The procedure is one that is 
known to comparatively few operators in this country, as it is 
not described in our * text-books and systems of surgery, 
although it is now seventy years since Walther, of Landshut, 
published a description of the operation, and since then such 
men as Oliver, Trelat, Poncet, Esmarch, and Volkmann have 
practiced it and written in its favor, as well as many others 
having less familiar names. But despite this amount of liter- 
ature on the subject, when the late Mr. Shuter, of London, 
showed a patient upon whom he had performed subperiosteal 
exarticulation at the hip-joint, at the Clinical Society of Lbndon, 
it was regarded by not a lew as almost a new departure in oper- 
4itive surgery. 

The special features of the method as explained in the 
Lancet consists in detaching a flap of periosteum from the por- 
tion of bone to be removed, sufficient to cover over the sawn 
end of the bone. The connections of this periosteal flap with 
the muscles on its outer surface must be carefully preserved, 
that there may be no interference with its nutrition; and to 
counteract its tendency to retract with the muscles, its cut 
•edges should be united by fine catgut, and great care be taken 
to secure rest to the stump by suitable compression. The 
detached periosteum should equal in length the diameter of the 
bone at the point of section, and the amputation flaps should 
be cut so that their base is this distance below the line of 
amputation ; then when they have been reflected up to their 
base, the periosteum should be divided circularly round the 
bone, and detached by means of an elevator or raspatory. 

The advantages that may be claimed for this mode of 
amputating are: (1) That the sawn surface of the bone is 
broueht into contact with the tissue which is physiologically 
fittea for its protection, and to which it becomes organically 
united most quickly and certainly; while, if the operation be 
•carefully done, no part of the bone is bared of periosteum, and 
its vitality thereby endangered. (2) That from the periosteal 
flap a thick layer of new bone is quickly develoned, which 
securely closes in the medullary cavity; by this ana the rapid 
primary adhesion of the periosteal flap, the medulla of the 
bone is guarded against the spread of any inflammation or sup- 
puration that n)ay be present in the soft parts of the stump. 
(3) That the stump is a better one than can be guaranteed by 
any other method, as there is no tendency for the bone to 
adhere to the cicatrix, and little if any liability of the bone to 
atrophy; the stump is firm, and the soft parts over it are mobile 
and supple. These are distinct advantages. But what can be 
said on the other side of the question? (1) That when flaps 
are well devised and made, and the wound properly treated, a 
mobile stump without adhesion of the bone to the cicatrix is 



166 EXTIRPATION OF THE UTERU8. 

obtained. (2) That muscle will adhere to the sawn end of a 
bone, and that in such a case the medullary canal becomes 
closed in by a plate of osseous tissue; this lamella is, however, 
much thinner and of later formation than when a periosteal 
flap is made. (3) That to detach and suture this flap of peri- 
osteum adds to some extent to the duration and difficulty of 
the operation. In the large majority of cases this objection 
should have no weight. As M. Nicaise points out in the current 
number of the Remie de Chirurgie, we have arrived at a period 
in the progress of surgery in which it is incumbent to study 
how, by attention to small details, we may give our patients the 
most .useful stumps, for the more important measures by which 
the operation of amputation has been deprived of its chief 
dangers are known and practiced with more or less success by 
all surgeons. (4) In young persons the preservation of a flap 
of periosteum may lead to an osteophytic outgrowth from and 
around the bone. The liability to this greatly lessens after 
adolescence. But it seems clear that it only occurs when there 
is inflammation of the tissues of the stump or some abiding 
irritation of the osteogenetic tissues of the periosteum. Ana 
now that we are able, in the great majority of cases, to exclude 
these processes with an approach to absolute certainty, this dis- 
advantage is not of great moment. 

These we believe are the arguments that may be advanced 
for and against this method of amputation. We cannot but 
think that, when carefully considered, they show a distinct 
balance in favor of the operation, and we hope that British sur- 
geons will devote more attention to it than heretofore, and thai 
we shall learn from them the results they obtain. 



EXTIRPATION OF THE UTERUS FOR CANCER. 



At the January monthly meeting of the London Obstetrical 
Society, a paper was read by Dr. W. A. Duncan on the above 
subject. The author related two cases in which he had done 
the operation, and based his arguments upon these and upon a 
table of cases which he had collected from various sources. 
The table, which had been printed and distributed amone the 
audience, contained many cases which had not before oeen 
published, and which might not have been brought to light but 
for Dr. Duncan's inquiries. The author's conclusions were 
adverse to the operation, on the grounds that the cases in 
which the disease was sufficiently localized to admit of removal 
with a good prospect of recovery and little risk of relapse, 
could be more safely and as eflectually treated by amputation 
of the cervix; while in cases in which the disease was too 
extensive to be thus removed the immediate danger of the oper- 
ation and the proneness to relapse, were so great that its per- 
formance was hardly justifiable. 



DENTISTRY IN JAPAN — ^MODERN THERAPEUTICS. 167 

DENTISTRY IN JAPAN. 



At a meeting of the Odontological Society of Great Britain, 
held in January, Dr. St. George Elliott exhibited three very 
curious and interesting specimens of Japanese artificial teeth. 
The Japanese, he said, were the only nation outside the limits 
of Western civilization who understood the fitting of artificial 
teeth. They had derived most of their scientific and technical 
knowledge from the Chinese, but in this matter they were in 
advance of their teachers, for the Chinese had no idea of fitting 
an artificial denture. They could, indeed, carve a row of incis- 
ors, and fasten them to the teeth on each side; but these pro- 
ductions were only intended for ornament, not for use, whilst 
those of Japanese manufacture were thoroughly efiicient. Thus 
a Japanese physician who came to Dr. Elliott for a set of teeth 
remarked that, though the foreign teeth were more natural in 
appearance, those of nome manuracture were auite as good from 
a practical point of view, and, in proof of this he took up a 
piece of hard "rock-candy," and crunched it between his false 
teeth. These dentures were made on wooden bases; the front 
teeth were made from quartz pebbles ground down, but the pro- 
cess of mastication was performed by copper-nails which occu- 
pied the place of the molars. It was an interesting fact, also^ 
that the nxing of dentures by means of suction had been known 
to the Japanese for at least two hundred years. The base- 
plates were carved by hand, the process being as follows : An 
impression of the mouth was taken in wax; £om this a model 
was made also in wax. The model was then coated all over 
with red pigment, and the plate, after being roughly shaped, 
was placed on the model thus colored. . The red patches on the 
under surface of the plate were then carefully cut away, until 
at last it fitted the model exactly. It was then tried in the 
mouth in the same way, the gums being covered with the pig- 
ment, and any inaccuracy readilv detected. Dr. Elliott stated 
that one of these dentures had been in use for fifteen years. 



MODERN THERAPEUTICS. 



In an interesting lecture delivered by Professor Horatio 
Woad {Medical limes), he gave his views of the teachings of 
the modem school of physiological therapeutics. According to 
this there is no known law of therapeutics unless it is that of 
antagonisms — ^^by which is meant tnat it is possible when a 
mass of Jiving protoplasm is depressed by some agent, to over- 
come the depression by a second agent which is stimulant to 
the protoplasm ; or in other words, that whilst some agencies 
increase the molecular movements of the protoplasm, others 
lessen them, and that it is at least theoretically possible to bal- 
ance more or less perfectly one of these forces against the 



168 MODERN THERAPEUTICS. 

other." According to the physiological method disease is first 
to be studied in its natural history, so as to define whether it 
has a definite course which cannot be arrested, and, if so, what 
is the progress of such course; whether the tendency is towards 
recovery or towards death, and. if the former, why it is some- 
times not fulfilled, that is, how death is produced in the excep- 
tional cases. If the tendency of a disease is fatal then the 
«tudy of the possibility of arresting it becomes a problem of 
.great interest. Next the therapeutist, by a study or the efiects 
of drugs and remedial agencies upon man and animals, endeav- 
ors to learn exactly how they act upon the human system, 
first in health and afterwards in disease. He then adapts his 
means to his ends by reasoning not very difierently from that 
which guides the chemist, the engineer, or anyone dealing with 
<lifScult force-problems. So long as it was assumed, that all 
-disease naturally tended towards death, our knowledge of the 
•natural history of disease made little progress; and the one 
^reat service performed by homoBopathy has been the showing 
that a large proportion of cases of disease, under proper nurs- 
ing, will get well without medical interference, and that the 
indiscriminate active medication by bleeding, salivation, etc., as 
3)racticed by our forefathers, robbed of life, many of the sick 
who would otherwise have recovered. Emboldened by results, 
properly educated practitioners, in perhaps the majority oi 
acute cases, now know exactly what they want to do in order 
to aid nature, and to steer the patient successfully past the 
dangers in the route along which ne must travel. 

^' It has been over and over again denied that we can reason 
from the action of drugs upon animals to their action on man ; 
l)ut it is not worth while to attempt to show in detail the 
absurdity of such denial. The whole evidence of modem 
•iscienoe indicates that, at least in his animal organism, man is 
not a mysterious creature apart from the rest of creation, but is 
•an animal having structural and chemical relations, within 
:and without, similar to those of other animals. As an instance 
and exemplification of these modem therapeutic principles we 
may cite chronic valvular disease of the heart. 6y a study of 
the disease we have learned that it has no definite course, and 
no tendency to cure ; that death in most cases is finally pro- 
duced by cardiac exhaustion ; that life is prolonged by a so- 
oalled compensatory hypertrophy ; and that if the increase of 
the heart-power be proportionate to the heart-work a comfort- 
able existence may be, in most cases, enjoyed almost indefin- 
itely. The clinician has thus learned that it is his function to 
:guide the patient whose heart is weak and has diseased valves, 
that, if it be possible, compensatory hypertrophy shall be 
Teached, He does this partly by proper attention to hygiene 
and partly by the use of a drug — digitalis — which chiefly by 
experiments on lower animals, he knows, quiets the excessive 



BREATHING THROUGH THE MOUTH. 169 

movements of a weak, irritable heart, by stimulating the inhibi- 
tory nerves, and, at the same time acts as a powerful tonic to 
the muscular walls of the heart, and especially aids the nutri- 
tion of the viscus by increasing the activity of its circulation. 
Summing up into a sentence, it may be said that the general 
principles which underlie rational therapeutics are to know 
what can be done, and what it is desirable shall be done; then 
to know the means at command; and, finally, to adopt the 
means to the end. At present the therapeutist is forced to sup- 
plement this principle by a pure empiricism, on account of 
the imperfection of our knowledge, not so much of the action 
of therapeutical remedies as of the nature of disease. We have 
no idea of the nature of malaria, or ot its immediate action on 
the human oi^Ranism. How can we tell in what way quinine 
vacts as a specific against it, a fact which we abundantly know 
•empirically? The best therapeutic practice of to-day is there- 
fore a mixture of science ana empiricism; but the science has 
•enormously increased in the last twenty years, and is advancing 
wifh arithmetical progression." 

BREATHING THROUGH THE MOUTH. 



In a paper read before the Canada Medical Association, at 
Montreal, August, 1884, by Dr. Georee W. Major (^New York 
Medical Recorai^ attention is called to uie causes, consequences, 
prevention ana cure of '* mouth breathing." This, he observes, 
is not simply a habit in some cases, but a necessity caused by 
some permanent mechanical obstruction to free respiration, 
-throuen the nostrils; in other cases it is a habit, formed in 
early life as the result of some temporary obstruction by swell- 
ing of the nasal mucous membrane or otherwise. While smell- 
ing is the function that would be naturally supposed as the 
most important performed by the nose, that of respiration is 
far more important as it purifies, moistens and modifies the 
temperature of the air before it reaches the larynx and the 
lungs. 

Dr. Major asserts that the habit of breathing through the 
mouth is productive of actual physical deformities ; deformed 
chest witn prominent sternum, sunken sides, retraction of 
the line of attachment of diaphragm and rounded shoulders, 
shortening of the upper lip and undtie prominence of the upper 
incisors and irregular development of the symphysis of the 
upper jaw ; flattening and thinning of the oIsr noat and wasting 
of the muscles of the nose and its neighborhood. He claims 
that these latter characteristics <ire more pronounced on the 
side where there is the greater obstruction. He claims that in 
aggravated cases there is also an expression of stupidity with 
loss of memory. He admits that the latter may be the result 
•of internasal pressure rather than of mouth breathing directly. 



170 CAUSATION OF LABOR. 

While the deformities of the mouth and nose are unquestion* 
ably the result of breathing through the mouth, it may be 
fairly doubted if the chest deformities are not rather due to the- 
obstruction which necessitates the mouth breathing. 

The occurrence of foul breath and decayed teeth are attri- 
butes to the habit, and that involuntary micturition during sleep 
mav also be caused by it As the habit is usualh contracted in 
early childhood, it is important that parents and nurses should 
be instructed as to the e^|pct of it, so that the attention of th& 
physician may be called at once, and if it be due to any per- 
manent obstruction of respiration, proper measures for ita 
removal be instituted. The principle causes are deviations of 
the nasal septum, outgrowths from the bones or cartilages of 
the nose, or of its mucous membranes, or from that of the 
pharynx or tonsils. 

Dr. Major regards deviation of the nasal septum as probably 
the most frequent cause of obstructed breathing and insists 
upon the necessity of surgical interference, giving preference to 
the method of Dr. Ingalls, of Chicago, in which the mucous 
membrane of the deviated side and cartilage are carefully 
divided in a triangular shape with the apex upward, the carti- 
lage dissected from the mucous membrane of the opposite side 
and removed, the septum being brought into line with pliers 
and the divided mucous membrane held by sutures and a pad 
of soft antiseptic material. The resiliency of the cartilage is 
such as to necessitate the removal of a portion equal to the 
redundancy in order to acquire a straight line. Of the various 
punches used he recommends only that of Savons, of Phila- 
delphia, in which a movable blade can be fixed at any angle 
ana the septum be divided through and stra^htened by allow- 
ing overlapping, and be held in place by plugs until healed^ 
He advises the removal of other forms of obstruction by hyper^* 
trophy of mucous membrane or tumors of any sort, their 
removal by means of the galvano-cautery. Bony growths he 
finds, are most satisfactorily removed with the surgical engine 
and burr. 



CAUSATION OF LABOR. 



In speaking of the causation of labor, Mr. Lawson Tait says 
{Medical Times and Oazette) that evidence is constantly estab- 
lishing the fact that the maturing and rupturing of the Graafian 
follicle has nothing to do with the periodical phenomena of 
menstruation. He is not prepared to say that the immediate 
agent exhists in the Fallopion tubes, but he is certain it is not 
in the ovaries. A great deal that has been assumed on thi& 
subject, would have to be abandoned, especially in reference to 
time occupied in the maturing of the follicle. That the uterus 
has any enect in determining the time of labor can be easily 



OONDEN8ATION8. 171 

disproved. A strong proof against the ovular theory of men- 
struation is that the removed of one ovary does not disturb 
either the periodicity or frequency of menstruation or labor; 
again, the removal of cystic ovaries during pr^nancy rarely ii 
ever interferes with its continuation until lull term. 

If we accept the theory of an inherited tendency to termin- 
ate labor at the beginning of the tenth month, we must have a 
determining cause or immediate mechanism. As to the separ- 
ation of the decidua being the cause of labor, he has proved to 
be erroneous by postmortem in a case of extra-uterine preg- 
nancy. The same is true as to the fatty degeneration oi the 
placenta. The true explanation, he believes, will be found in 
the peculiar rvthmetical contractions of the pregnant uterus first 
pointed out by Dr. Braxton Hicks. These contractions occur 
throughout the entire course of pregnancy, and constitute the 
most certain and constant sign of pregnancy even as early as 
the third month. Mr. Tait does not admit that abortion or 
miscarriage occurs invariably at a period corresponding to a 
menstrual epoch. His experience has been altogether against 
this view. 



CONDENSATIONS. 



A CORRESPONDENT in the London Lancet writes that any one 
may be cured of stammering by simply making an audible note 
in experation before each word. 

Professor Bartholow recommends a combination of mor- 
phia and atropine for the cough of bronchitis when it is accom- 
panied by an abundant secretion. 

Dr. a. L. Ranney has been appointed to fill the chair of 
anatomy in the University of the City of New York, made vac- 
cant by the 'i'eath of Professor Darling. 

It is now proposed to vaccinate by subcutaneous injections 
of the fresh vaccine lymph. Bourreous, an eminent French 
authority, has employed this method with success. 

Many friends will be gratified to know of the entire success 
of the operation for the removal of cataracts from the eyes of 
Professor Henry F. Campbell, the distinguished president of 
the American Medical Association. 



The approaching meeting of the American Medical Asso- 
ciation, to be held in New Orleans, commencing Tuesday, April 
28, and continuing four days, will be largely attended. The 
low railroad fare and the exposition will be the inducements 
for many northern physicians to attend. 



172 00NDEN8ATION8. 

AcooRDiNo to a writer in the Okemical News^ the painful 
bum produced by nitric acid may be successfully treated by a 
•dilute solution of sulphurous acia applied instantaneously. 

The investigation of a case of death in England from the 
use of methylene as an anaesthetic developed the fact that it is 
one of the safest of ansesthetics. At the inquest it was shown 
that the number of deaths caused by it is one in eight thousand. 

Thallin, the last new antipyretic has been introduced by 
iDr. V. Jakoch, of Vienna. It is one of the chinolin compounds, 
And is a powerful antifermentative. Jakoch has used it in 
eighty-six cases, and found that, although a powerful antipy- 
retic, it is not a specific. 

M. DiANOux (Paris Medicai) states that having exhausted all 
<known remedies in the treatment of herpes of the cornea, he 
•applied dry finely pulverized iodoform upon an ulcer of the 
*cornea, closed and bandaged the lids. In a few days the ulcer 
began to cicatrize. In forty cases of this intractible disease he 
thas met with like success. 



Rheqolkne, a product of petroleum, is again brought to 
motice, by Dr. G. S. Ryerson in the Canadian Pra^itioner, as a 
local ansBsthetic. In the form of spray it will freeze the tissues 
more rapidly than ether, and also to a greater depth. In about 
•one minute's application of the spray all sensibility ceases and 
both superficial and deep tissues may be cut without pain or 
^haemorrhage. 

The removal of a rapidly growing malignant tumor from 
the posterior nares of a young lady, which under the micro- 
scope was shown to be an ostrea edtUiey illustrates how easily 
foreign bodies may become lodged in the nasal passage, and 
being overlooked, become the source of purulent nasal dis- 
charge. The presence of a foreign body may, by pressure on the 
terminal filaments of the fifth carnial nerve, produce remote 
•effects, and by reflex vaso-motor action give symptoms of 
serious cerebral disease. 



The Administration of Phosphorus.— M. Pierre Virgier 
concludes an interesting communication on the pharmacolo^ 
•of phosphorus (^Gazette hebdomadaire de Medicine et de Chirurgve) 
with the statement that its administration should be limitea to 
the two following forms: (1) The phosphide of zinc, in pill of 
eight milligrams, corresponding to one milligram of phos- 
phorus, of which from two to eight may be taken daily. (2) 
rhosphorated oil, one per cent, in capsules of ten centigrams 
•each, containing one milligram of phosphorus. 



CONDENSATIONS. 17$ 

Dr. Spencer reported at the Saint Louis Medico-Chirurgical 
Society iOourier of Medicine) a case of severe asthma due to- 
reflex irritation from a large nasal polypus. The asthmatic 
symptoms had been of the most exasperating kind. These 
attacks had come on periodically for a number of years. Her 
physician had treated her as those cases are ordinarily treated, 
and latterly had given her nitrite of amyl for the relief of the 
attacks. The polypus was a very large one, and immediately 
upon removing it sne had relief from her symptoms and has 
never had a recurrence. 



Professor Hebra advises the following abortive treatment 
of soft chancre: After thoroughly cleaning the sore, it should 
be treated with a preparation of spirit and potash-soap, care- 
fully dried, and pure salicvlic acia applied to the sore, which 
must be covered up with plaster. The treatment succeeds best 
when this application is renewed for two successive days, and 
the sore suppurates freely. After three days the sore is covered 
with a white scab. The salicylic acid should now be adandoned 
and an enrollient ointment spread on lint employed as a dress- 
ing. The scab speedily separates, and the wound readily 
heals, without any likelihood of a bubo forming. 

The skin ranks in importance next to the alimentary canal 
as a means for the introduction of remedial agents into the 
system, as well as a medium through which the effete materials 
of the body are cast off, and the necessity of the full and per- 
fect performance of their functions have the same relative 
importance. The skin not only has its own work to perform, 
but at times is made to carry on part of the function of lung 
and kidney. If the ancients were not acquainted with these 
facts, they, at least, recognized the benefits of keeping the cir- 
culation and the excreting follicles active, by frequent bathing. 
In every age the bath has been a mark of civilization and 
refinement; and for a long period they were so elaborate that 
only the wealthy could afford the luxury. But the bath is no 
longer a luxury, it is a necessity, and many other daily neces- 
sities of this age were formerly only within the reach of opulent 
ancients. The portable baths that are now manufactured, are 
so convenient and cheap that bathing can be indulged in at 
home by almost any person. 

Treatment of Delirium Tremens. — At the conclusion of a 
lengthy article on '* Delirium Tremens and its Treatment" in 
the Tnerapeutic Oazette, Dr. £. P. Hurd, gives the general rules 
oi treatment as summed up by Laycock in Braithwate^a Retro- 
spect as follows: (1) The patient should be placed in as com- 
plete a state of muscular repose as possible, for muscular activ- 
ity exhausts the nervous system. Should his delirium be of a 



174 NEW PUBLICATIONS. 

violent kind, chloroform would be a better and a safer remedy 
than the straight-jacket. (2) All sensational stimuli should \k 
removed and all emotions as far as possible prevented. (3) 
Food of a suitable kind should be carefully given, no alcoholic 
stimuli of any kind bein^ administered, unless especially indi- 
cated. (4) When there is a tendency to diaphoresis it should 
be encouraged as an eliminatory process. (6) The surface, and 
ebpecially tne feet, should be kept warm. (6) An experienced 
nurse should" attend the patient. To these rules Dr. Hurd 
would add, as medicinal measures, the judicious administration 
of morphia hypodermically, and chloral hydrate and tincture 
of capsicum, each one-half ounce in pepermint water six and 
one-half ounces, to be given in tablespoonful doses every two 
hours until sleep is induced. 



NEW PUBLICATIONS. 



THE STUDENT'S MANUAL OF HISTOLOGY, FOR THE USE OF 
STUDENTS, PRACTITIONERS AND MICROSCOPISTS. Third 
edition, entirely rewritten, sreately enlarged, and newly illus- 
trated By Charles H. Stowell, M. D., F. R. M. S., Professor of His- 
tology and Microscopy, and in Charge of the Histological Labora- 
tory of the University of Michigan. Illustrated by one hundred 
and seventy-eight engraving. Ann Arbor, Michigan : Charles H. 
Stowell, Publisher, 1884. 

Histology has been able to make many long and rapid 
strides in the past few years, owing to better instruments, and 
improved methods of staining. This advancement of the sub- 
ject, necessitates frequent revisions of works of histology and 
microscopy. No author has been more assiduous in trying to 
keep his work abreast with the information of the day tnan 
Professor Stowell. The first edition of *'The Manual" was 
issued in 1881, and in less than four years a third edition is 
in the hands of students and investigators. Many changes 
have been made in text and plates. Some features of the 
former editions which excited sharp but just criticism have dis- 
appeared. The book is well arranged, written in a pleasing 
st3rle, couched in plain untechnical language, and maoe agree- 
able to the reader's eye by the clear type and press-work, and 
the superior quality of the paper. 



THE LONDON MEDICAL STUDENT AND OTHER COMICALI- 
TIES. Selected and compiled by Hugo Erichsen, M. D. Published 
by Dr. H. Erichsen, 11 Farmer street, Detroit Michigan. Ann 
Arbor: Geo. Osius & Co. Price, $2 00. 

This little work is designed to banish " the blues," to relieve 
mental depression, to excite mirth, and provoke laughter. No 
other creature than man, experiences the pain and pleasure of 
these emotions. Hazlitt says, "Man is the only animal tliat 



NBW PUBLICATIONS. 175 

laughs, for he is the only animal that is struck with the differ- 
ence between what things are and what the^ ought to be." 

The experiences of the "London Medical Student" com- 
prise the greater part of the book. The narrative is taken from 
the London Punch, where it was published about a half century 
ago. "Despite my strenuous eflforts," the author says, "1 
could not detect who wrote the sparkling portraiture of med- 
ical-student-life, in the greatest metropolis of the world, but I 
was convinced by my investigation that its authorship belongs 
to Hood, Dickens, Thackeray, Mark Lemon, or Douglas Jer- 
rold. Of one thing, however, I am absolutely certain, that is, 
that I am the first to introduce my friends, Mr. Muff and J. 
Randall, Esq., to the Medical profession at large." 

The many funny and witty anecdotes which constitute the 
balance of the work are quite humorous and sparkling and 
admirably tend to "drive dull care away." 



BOOKS AND PAMPHLETS RECEIVED. 



INAUGURAL ADDRESS DELIVERED BEFORE THE NEW YORK 
ACADEMY OF MEDICINE. By the President of the Academy. 
Reprinted from the Medical Record^ February 14, 1885. New York: 
Trow's Printing and Book Binding Company, 1865. 

VITAL STATISTICS IN TENNESEE. A report by J. D. Plunket, M. 
D., of Nashville, Tennessee, Member of the State Board of Health 
and its committee on vital statistics. Reprinted from the second 
report of the State Board of Health, January 1, 1885. 

REMARKS ON TYPHOID FEVER IN THE YOUNG, By. A. Jacobi, 
M. D., Clincial Professor of Diseases of Children in the College of 
Physicians and Surgeons in New York. Reprinted from the 
Archivei of Pediatrics^ March, 1885. Philadelphia: John E. Potter 
& Co., Publishers, 1885. 

THE SPECIAL ANTHROPATHES: A clinical report of six cases of 
Charcot's joints, with illustrations. By A. Sidney Roberts, M. D., 
Surgeon to the Philadelphia Hospital ; Orthopsedic Surgeon to the 
Out-patient Department of the University Hospital; Instructor in 
Orthopsedic Surgery In the University of Pennsylvania. Reprinted 
from the Medical News, February 14, 1885. Philadelphia: Printed 
by Wm. J. Dcrnan, 1885. 

A MANUAL OF ORGANIC MATERIA MEDICA : BEING A GUIDE 
TO MATERIijilEDICA OF THE VEGETABLE AND ANIMAL 
KINGDOMS, FOR THE USE OF STUDENTS, DRUGGISTS. 
PHARMACISTS AND PHYSICIANS. By John M. Maisch, Phar! 
D., Professor of Materia Medica and Botany in the Philadelphia 
College of Pharmacy. Second edition. With two hundred and 
forty-two illustrations. Philadelphia : Lea Brothers A Co., 1885. 

THE PHYSIOLOGICAL EFFECTS AND THERAPEUTICAL USES 
OF HYDRASTIS. By Robert Bartholow. A. M., M. D., LL. D., 
Professor of Materia Medica and General Therapeutics in the Jef- 
ferson Medical College of Philadelphia; Author of "A Practical 
' Treatise of Materia Medica and Therapeutics,'' of ''A Treatise on 
the Practice of Medicine^" etc. Reprint from the Drugs and Medi- 
cines of North Americaf March, 1885. Issued by J. U. & C. G. Lloyd, 
Cincinnati. Ohio. 



176 NEW PUBUCATI0N8. 

REPORT OF COMMITTEE ON SCHOOL HYGIENE IN TENNE- 
SEE. By Daniel F. Wright, M. D.. of Clarksville, Tennesee, Mem- 
ber of State Board of Health, and Chairman of its committe on the 
subject. Reprinted from the second report of the State Board of 
Health; January 1, 1885. 

THE OLEATES: FURTHER INVESTIGATION INTO THEIR NA- 
TURE AND ACTION. Introduction to a Discussion in the Section 
of Pharmacolosy and Therapeutics, at the fifty-second annual 
meeting of the British Medical Association, held at Belfast, July 
30, 1884. By John V. Shoemaker, A. M., M. D., Lecturer on Der- 
matology at the Jefferson Medical College ; Phvsiciait to the Phil- 
adelphia Hospital for Skin Diseases, Philadelphia. Philadelphia: 
F. A. Davis, Attorney, 1886. 

THE TREATMENT OF DISEASES OF THE SKIN BY NOVEL 
MEANS AND METHODS. A paper read before the Section of 
Dermatology and Syphilis, at the meeting of the International 
Medical Congress at Copenhagen, Denmark, August 12, 1884. By 
John V. Shoemaker, A. M.,M. D., Lecturer on Dermatology at the 
Jefferson Medical College and Instructor thereon in the Post- 
Graduate Course of that institution; Plivsician to the Philadel- 
phia Hospital for Skin Diseases, etc. Philadelphia: 1885. 

ADDRESS IN MEDICINE. Delivered before the Medical Society of 
the State of Pennsylvania, at Philadelphia, May, 1884. By W. 
H. Daly, M. D., Pittsburgh, Penns3^lvania, one of the Vice-rresi- 
dents of the American I^ryngological Association ; Senior Physi- 
cian for Diseases of the Nose, Throat, and Chest, to the Pittsbnreb 
Free Dispensary, Pittsburg, Pennsylvania; Senior Physician to tne 
Western Pennsylvania Hospital, Pittsburs Pennsylvania: Ex* 
President of the Allegheny County Medical Societv ; Member of 
the British Medical Association, et<:., et^. Reprint from its Trans- 
actions. Philadelphia : Collins, 1884. 

THE YEAR-BOOK OF TREATMENT FOR 1884 ; A CLINICAL RE- 
VIEW FOR PRACTITIONERS OF MEDICINE AND SURGERY. 
Contributors: J. Mitchell Bruce, M. D, T. Lander Brunton, M. D., 
F. R. S., Thomas Bryan, F. R. C. S., F. H. Champneys, M. B., 
Alfred Cooper, F. R. C. S., Sidney Coupland, M. D., Dyce Duck- 
worth, M. D., George P. Field, M. R. C. S., Reginald Harrison, F. 
R. C. S.. J. Warrington Howard, F. R. C. S., F. A. Mahomed, M. 
D., Malcolm Morris, F. R. C. S., Edinburgh, Edmund Owen, F. R. 
C. S., R. Douglas Powel, M. D., C. H. Ralfe, M. D, A. E. Sansom, M. 
D., Felix Lemon, M. D.. Walter G. Smith, M. D., J. Knowsley 
Thornton, M. B., Frederick Treves, F. R. C. S., Arde Watteville, 
M. D., John Williams, M. D. Philadelphia: Lea Brothers k 
Co., 1885. 

THE SCIENCE AND ART OF SURGERY. A TREATISE ON SUR- 
GICAL INJURIES, DISEASES AND OPERATIONS. By John 
Eric Erichsen,F.R S.,L. L. D., F. R. C. S., Surgeon Extraordinary 
to her Majestv the Queen ; Ex-President of the Royal College of 
Surpeons of England and of the Royal Medical and Chirurgical 
Society; Emeritus Professor of Surgery and of Clinical Sui^ery in 
University College ; Consulting Surgeon to University College Hos- 
pital, and to many other Medical Charities. Eighth edition, revised 
and edited by Marcus Beck, M. S., and M. B., London, F. R. C. S., . 
Surgeon to University College Hospital; and Professor of Clinical 
Surgery in University College^ London. Nine hundred and eighty- 
four engravings on wood. Volume II: Philadelphia: Lea Broth- 
ers & Co., 1885. 



massagk: its aktiquity and uses. 177 

MEDICAL DIGEST. 



MASSAGE: ITS ANTIQUITY AND USES. 



Homer in the Odyssey tells us that beautiful women rubbed 
and annointed war-worn heroes to rest and refresh them. In 
another part of the Odyssey (III, 446) we read, " Meanwhile 
she bathed Telemaehus, even fair Polycaste, the youngest 
daughter of Nestor. And after she had bathed him' and 
annointed him with olive oil, and cast about him a goodly 
mantle, he came forth from the bath in fashion like the death- 
less godsi" And again (XXIV, 364), '*The Sicilian handmaid 
bathed high-hearted Laertes, and annointed him with olive oil 
and cast a fair mantle about him." Such kindly marks of 
attention, we trust, were more for precept than example. Odys- 
seus was more modest in accepting sucn hospitalities. '' Then 
goodly Odysseus spake among the maidens, saying, 'I pray 
you stand thus apart, while I myself wash the brine from my 
shoulders, and annoint me with olive oil ; but in your sight i 
will not bathe, for I am ashamed to make me naked in the 
company of fair-tressed maidens.' " 

"The art of medicine is thus divided among them; each 
physician applies himself to one disease only, and not more. 
All places aoound in physicians ; some physicians are for the 
eyes, others for the head, others for the teeth, others for the 
parts about the belly, and others for internal diseases." " The 
physician must be experienced in many things," says Hippo- 
crates, "but assuredly also in rubbing; for things that have 
the same name have not always the same eflfects. For rubbing 
can bind a joint that is too loose, and loosen a joint that is 
too rigid." And again, "rubbing can bind and loosen; can 
make flesh and cause parts to waste. Hard rubbing binds; 
soft rubbing loosens; much rubbing causes parts to wnste; 
moderate rubbing makes them grow." This is the earliest 
definite information about massage. Asclepiades thought that 
physicians ought to cure their patients safely, speeduy, and 
pleasantly; and he relied mainly on diet, bathing, exercise, and 
iriction. His representation of treatment by motion found great 
respect. He considered that the body was composed of innu- 
merable canals endowed with sensation and regularly distrib- 
uted, in which moved the nutritive juices and plastic atoms. 
So long as this went on without disturbance health continued ; 
on the contrary, disturbance caused sickness. The normal 
movement of the juices would be disturbed by abnormal 
increase of these atoms, by their irregular distribution, by too 
great blending to^etbcr, and by too swift motion of the same 
and also by constriction and dilation of their canals. Proceed- 
ing upon these principles, Asclepiades renounced almost en- 

L 



178 massage: its antiquity and uses. 

tirely the use of medicine and attempted to restore free move- 
ment of the nutritive fluids and atoms by means of rubbing; 
that gentle stroking had a soporific influence. With this he 
also combined active passive motion. 

Cicero considered that he owed as much of his health to 
his annointer as he did to his physician. Plutarch tells us that 
Julius Csesar had himself pincned all over daily as a means of 
getting rid of a general neuralgia. Celsus spoke wisely and well 
about rubbing in saying that it "should sometimes be applied 
to the whole bodv, as when an invalid requires his system to be 
replenished." Tne Emperor Hadrian, one day seeing a veteran 
soldier rubbing himsen against the marble at the public baths, 
asked him why he did so. The veteran answered, "I have no 
clave to rub me;" whereupon the emperor gave him two slaves 
and sufficient to maintain them. Another day several old men 
rubbed themselves against the wall in the emperor's presence, 
hoping the similar good fortune, when the shrewd Hadrian, 
perceiving their object, directed them to rub one another. 

The health of tne celebrated Roman advocate, Plinv, which 
was never very strong, had been shaken by a severe illness the 
preceding year. He availed himself of a mode of treatment 
'which it is presumed was much in vogue at that time. He 
procured the services of a medical practitioner who cured many 
of his patients by the process of rubbing and annointing, and so 
much oenefit di5 he aerive from the remedy that he asked the 
«mperor to grant the physician, who was either a Jew or a 
Greek, the freedom of the city and the privileges of Roman 
citizenship. Arrian, who probably lived about the year of our 
Lord 243, says, "And great is the advantage of rubbing to the 
dog of the whole body — not less than to the horse, tor it is 
good to knit and to strengthen the limbs, and it makes the 
hair soft and its hue glossy, and it cleanses the impurities of 
the skin. One should ruo the back and the loins with the 
right hand, placing the left under the bell v, in order that the 
dog may not be hurt from being squeezed from above into a 
crouching position; and the ribs should be rubbed with both 
hands; and the buttocks as far as the extremities of the feet; 
and the shoulder-blades as well. And when they seem to have 
had enough, lift her up bv the tail, and having given her a 
stretching, let her go. And she will shake herself when let go, 
and show that she liked the treatment." Oribasius, a Greek, 
who early acquired a high reputation and was taken bv the 
Emperor Julian to Gaul as his physician, wrote: "But all the 
jjhysicians and philosophers of antiquity knew no better means 
of strengthening the vital principles and prolonging life than 
moderation ; bv the use of free and pure air and bathing, and 
above all by daily friction of the body and exercise. Rules 
and directions were laid down for giving genUe and violent 
motion to the body in a variety of ways, hence arose a particu- 



massaqe: its antiquity and uses. 179 

lar art called the gymnastic; and the greatest philosophers and 
men of learning never forgot that the body and soul ought to 
be exercised in due proportion. This art of suiting exercise to 
the different constitutions, situations and wants of man; of 
employing it above all as the means of keeping his internal 
nature in proper activity, and thereby not only rendering the 
causes of disease ineffectu il, but also curing diseases which 
have already appeared, they indeed brought to an extraordi- 
nary degree of perfection." 

Paracelsus, a remarkable man, though often intoxicated, and 
ffuilty of gross immoralities, extols the effects of friction on the 
human body as indispensable to health. Ambroise Pare, the 
most renowned surgeon of the sixteenth century, though not 
recognized by the faculty as he was only a barber-surgeon, the 
inventor of the ligation of arteries which is the foundation of 
modem surgery, surgeon under four French kings, a devout 
Huguenot but spared at the massacre of ^aint Bartholomew 
on account of his surgical skill, ^ood old Ambroise* states that 
friction was in great esteem in his time. He describes three 
kinds of friction — gentle, mediuni, and vigorous — and the 
effects of each. In dislocations he recommends that the joint 
should be moved about, this way and that way, not violently 
but in order to resolve the effused fluids and extend the fibres 
of the muscles and the ligaments, so as to facilitate the reduc- 
tion. From this it is apparent that he knew the influence of 
Eassive motion in promoting absorption, the rationale of which 
as been so'well studied b^ German phvsiologists. 
Alpinus, in his ^'Medicina i&gyptia,'' says that frictions are 
so much in use among the Egyptians that no one retires from 
the bath without beins rubbed. For this purpose the person 
is extended horizontally; then he is malaxated, manipulated, 
or kneaded and pressed in divers manners upon the various 
parts of the body with the hands of the operator. Passive 
motion is then given to the different articulations. Not satis- 
fied with masseing, fiexing and extending the articulations 
alone, they exercise the same pressures and frictions upon all 
the muscles, the effect of which is thus described by Savary : 
" Perfectly mass^ed, one feels completely regenerated, a feeling 
of extreme comfort pervades the whole system, the chest 
expands, and we breathe with pleasure; the blood circulates 
with ease and we have a sensation as if freed from an enormous 
load; we experience a suppleness and lightness till then un- 
known. It seems as if we truly lived for the first time. There 
is a lively feeling of existence which radiates to the extrem- 
ities of the body, while the whole is given over to the most 
delightful sensations; the^mind takes cognizance of these, and 

^Professor Gross narrates that when Ambroise Par6 was a younff 
man he lived with a noble family to do the shaving, the surgery, and 
to read the family prayers. 



180 massage: its antiquity and uses. 

enjoys the most agreeable thonghts; the imagination wanders 
over the universe which it adorns, sees every where smiling 
pictures, every where the ima^e of happiness. If life were only 
a succession of ideas, the rapidity witn which memory retraces 
them, the vigor with which the mind runs over the extended 
chain of them would make one believe that in the two hours 
of delicious calm which follow a great many years have passed." 

Fabricius ab Aquapendente most warmly recommended this 
treatment by rubbing, kneading, and scientific movements as 
a rational measure in joint affections. Hofiinan, whom we are 
not likely to forget' so long as the anodyne which still bears his 
name continues to be so useful, says that exercise is the best 
medicine for the body, and that we cannot imagine how salu- 
tary and favorable • to the health it is, for it excites the flow of 
the spirits, and facilitates the excretions from the blood. He 
extols the passive, active, and mixed movements of the ancients 
as well as the apotherapeia already referred to. 

In the island of Tonga, Oceanica, when a person is fatigued 
from walking or other exercise he lies down, and some of the 
natives practice divers operations upon him known under the 
name of toogi-toogi^ mili or fota. The first of these words 
expresses the action of striking constantly and softly with the 
fist; the second that of rubbing with the palm of the hand; 
the third that of pressing and squeezing the tissues between the 
fingers and the thumb. These operations are ordinarily done 
by females; and. they contribute to diminish fatigue and pain, 
besides producing an agreeable effect which disposes to sleep. 
When they practice them with the intention of diminishing 
fatigue alone, the arms and legs are worked upon ; but when 
there is pain in some place it is the part affected or the sur- 
rounding parts where the operations are applied. Jn headache 
the skin over the frontal region and also tnat of the cranium is 
submitted of fota, and often with success. Sometimes in cases of 
fatigue they make use of a process which differs from the pro- 
ceeding ordinarily employed; three or four little children tread 
under their feet the wnole body of the patient. 

In 1870, Dr. N. B. Emerson gave a very interesting account 
of the lomi'lomi of the Sandwich Islanders. He describes it as 
a luxurious and healthful form of passive motion which the 
Hawaiians bestow upon each other as an act of kindness and 
their crowning act of generous hospitality to a well-behaved 
stranger. When foot-sore and weary in every muscle so that 
no position affords rest and sleep cannot be obtained, it relieves 
the stiffness, lameness, and soreness, and soothes to sleep, so that 
unpleasant effects of excessive exercise are not felt next day : 
but in their stead a suppleness of muscle and ease of joint 
entirely unwonted. Moreover, the lomi-lomi is capable of 
appeasing and satisfying that muscular sense of ennui which 
results from a craving for active physical exercise. 



TREATMENT OF EPILEPSY. 181 

Nordhoff, in his book on '* Northern California, Oregon, and 
the Sandwich Islands," give the following graphic description 
of lomi'lomi: "Wherever you stop for lunch or for the night, 
if there are native people near, you will be greatly refreshed by 
the application of lomi'lomi. Almost everywhere you will find 
some one skilled in this peculiar and, to tired muscles, delight- 
ful and refreshing treatment, To be lomi-lomied you lie down 
upon a mat, or undress for the night. The less clothing you 
have on, the more perfectly the operation ean be performed. 
To you thereupon comes a stout native with soft, fleshy hands 
but a strong grip, ^nd beginning with your head and working 
down slowly over the whole body, seizes and squeezes with a 
quite peculiar art ever^*^ tired muscle, working and kneading 
with indefatigable patience, until in half an hour, whereas you 
were weary and worn out, you find yourself fresh, all soreness 
and weariness absolutely and entirely gone, and mind and bod^ 
soothed to a healthful and refreshing sleep. The lomi'lomi is 
used not only by the natives, but among almost all the foreign 
residents; and not merely to procure relief from weariness con- 
sequent on over-exertion, but to cure headaches, to relieve the 
aching of neuralgic and rheumatic pains, and by the luxurious 
as one of the pleasures of life. I have known it to relieve vio- 
lent headache in a very short time. The chiefs keep skillful 
lomi'lomi men and women in their retinues, and the late king, 
who was for some years too stout to take exercise, and yet was 
a gross feeder, had himself lomi-lomied after every meal as a 
means of helping his digestion. It is a device for relieving 
pain and weariness which seems to have no injurious reaction 
and no drawback but one — it is said to fatten the subjects of it." 
— Douglas Graham, M. D., on* Massage. — Practitioner, 



TREATMENT OF EPILEPSY. 



Vice-President Dr. Charles K. Mills read a paper at the 
Philadelphia Netxrological Society on the medical treatment of 
epilepsy proper, — ^grand mal and petit mal. 

As to the curability of epilepsy, some appiirently authentic 
cases of cure were on record. He could recall only seven cases 
of apparent or real cure.in his own practice, private or hospi- 
tal. A large list of remedies were enumerated which were used 
singly three or four times daily, in a series of cases during the 
last ten years. The bromides were certainly the best remedies, 
and the bromide of potassium, in his opinion, stood at the head 
of the list. The bromide of sodium came next. He thought 
the bromides aflTected the nerve centres directly. The mixed 
bromides were better, usually, than any one of them used 
singly. The bromides could be quite advantageously combined 
with other drugs. The best combination for long continued use 
was bromide of potassium, fifteen grains; bromijde of sodium, 



182 RAPID CUBE OF SIMPLE CHANCRE. 

fifteen grains; solution of the arsenite of potassium (Fowler's 
solution), two minims; conium juice, one-half fluid drachm; or 
the fluid extract of conium, three to five minims. This was gener- 
ally made up with syrup of orange and some bitter effusion. An- 
other pood combination was bromide of potassium and tincture 
of digitalis. It was only especially valuable in cases compli* 
cated with weak heart or mitral disease. Mono-bromide of 
camphor had no advantage over the bromides. Hydrobromic 
acid was efficient in very large doses but so much water had to 
be given with it, that the amount to be swallowed was appall- 
ing to the patient. It sometimes irritated t^e stomach. Borax 
was not of established value, but helped in a few cases tempo- 
rarily. He found iodide of potassium, unless especially indi- 
cated, had little value when used alone in the treatment of 
epilepsy. Chloral hydrate "is not of much value when given 
alone, but with the bromides, in cases uncomplicated with car- 
diac disease, it sometimes makes a useful combination. Trous- 
seau's belladonna treatment had been used without noteworthy 
success. Cannabis indica was not to be depended upon. H!e 
had tried cocculus indicus in six cases at the Philadelphia 
Hospital. None improved and four were made worse by its use^ 
one of the four becoming insane while taking the drug. 

The way to treat epilepsy, in his opinion, was to simply 
have a plan of treatment and carry it out over a series of 
months or years. He would first put a patient upon a single 
bromide, say fifteen grains three times a day, to oe increased 
until a decrease in the number and severity of the paroxysms 
was produced. This continued for months : then use the mixed 
bromides or some combination of bromides with other drugs. 
He watched the condition of the patient, and, if necessary, also 
put him on cod-liver oil, quinine or iron. He believes that 
close attention should be paid to every point in the daily life 
of an epileptic — to diet, rest and hygiene. 

Among the surgical and external means of treatment he 
had successfully used were excision of cicatrix, removal of neu- 
roma, actual cautery, and blistering to the neck and head. He 
had not used counter-irritation to the scalp but was a stroncc 
believer in the actual cautery, used after Brown-Sequard's 
method, to the nape of the neck. 



RAPID CURE OF SIMPLE CHANCRE. 



Dr. Barthelemy gives in V Union. Medicale, the method 
employed by Hebra, of Vienna, and which consists of washing 
carefully the penis of the patient with warm water, oil ana 
soap, so as to remove all traces of previous treatment, and such 
topical applications as might form caustic combinations with 
salicylic acid. Then the salicylic acid is applied so as to cover 
only the chancre and a very small peripheral zone; this is kept 



USES OF HAMAMELIS VIKGINICA. 183 

in place by a thin layer of wadding, and covered by a strip of 
adnesive plaster. The anpUcation is made once daily if sup- 
puration is not very abunaant, if it be, twice dailv, morning and 
evening. By the third day an eschar is formed which is deep 
enough to destroy all the evidence of the ulceration ; then the 
salicylic acid is stopped and a simple ointment, such as pre* 
pared adeps, is used spread on linen. Ordinarily the eschar come» 
away in half a day, leaving behind a simple lesion deprived of 
all virulence and healing in two or three days. 

THERAPEUTICAL USES OF HAMAMELIS VIRGINICA. 



"This agent has been termed," says Dr. Davis, in the AfecF- 
teal THmea, "the aconite of the veins as its range of action seems 
to be as thoroughly confined to this portion of the blood-vessels 
as aconite is to the arterial system." 

" The three leading forms of venous disorders are varicosis^ 
phlebitis, and hsemorrhage. In the various forms of varicosis^ 
hamamelis virginica is the prince of remedies. In varicose 
veins of the leg, small doses will give prompt relief, by allaying 
the pain and inflammation, and contracting the vessels grad- 
ually to their normal positions. A local application well 
diluted should also be made over the limb, to cause the surface 
veins to shrink up. Varicose ulcer of the leg may be healed 
by similar treatment. Also varicocele has often yielded. For 
varicosis of the throat, where the parts look bluish from dis- 
tended veins, and there is more or less discomfort, with pain on 
swallowing, and hawking of mucus with blood. Such a throat 
is often seen in goutv subjects, but it is in this same condition 
at the other end of the digestive tube, namely, in haemorrhoids, 
that hamamelis has won its greatest reputation. 

"Some writers have become so enthusiastic as to assert that 
this agent is a specific for piles. These strong assertions have 
led to the indiscriminate use and abuse of the remedy in all 
forms of rectiil disorders. It is, in fact, one of our best known 
remedies for hsemorrhoidal aflTections, if they depend upon vari- 
cosis, and this remedy is properly administered. • I advise that 
the remedy be used in small dosss, frequently repeated, until 
the characteristic physiological effect upon the veins are appar- 
ent, and that its effects be maintained for several days; and at 
the same time the remedy should be applied in the form of a 
diluted tincture, ointment or suppository to the affected parts. 
In venous hsemorrhage, hamamelis is one of our surest remedies. 
Cases indicating its use are those where the blood flows steadil}^ 
and without expulsive effort. It is more suitable when the 
state of the vessels leads to the hsemorrhage than when this is 
dependent upon altered composition of the blood itself. If 
this latter suggestion be true, it defines the place of hamamelis 
in pupura. There are many cases on record showing its 



184 A8EPT0L: THE NEW ANTISEPTIC. 

efficacy. EpiBtaxi?, hsemoptjsis, and hsBmaiemesis of a passive, 
venous type, are readily controlled by hamamelis. Dr. Ringer 
has highly recommended this agent to arrest hsematuria, and 
to check the oozing of blood, which sometimes goes on for weeks 
after delivery. Dr. Hughes asserts that it has cured many 
cases of vicarious menstruation, and benefitted many cases of 
chronic dysentery. In simple phlebitis, you can hardly put 
too much confidence in hamamefis. Recently I have prescrioed 
it in some severe cases of orchitis, accompanied with much pain 
and swelling of the testicles, using the remedy locally and 
internally. Impotency, where the organs are greatly relaxed, 
and perspire constantly, has been corrected b^ it. Varicosis of 
the spermatic veins, testicles much swollen, with drawing pains 
in the spermatic cord, require the local and internal use of 
hamamelis. Many diseases peculiar to females are much ben- 
efited by this agent. I will mention a few of them. Passive, 
venous uterine hsemorrhage, the discharge being dark, and the 
uterine walls much relaxed. Leucorrhoea, with much relaxa- 
tion of the uterine walls. Dysmenorrhoea, with ovarian irrita- 
tion. Varicose veins in the limbs of pregnant women. It is 
also highly beneficial in the treatment of both acute and chronic 
inflammation or the conjunctiva, and in muscular and articu- 
lar rheumatibm, characterized by great pain on moving, or 
sensitiveness to touch, the remedy being used locally and 
internally." 

ASEPTOL: THE NEW ANTISEPTIC. 



This new phenol compound has recently been brought to 
the notice of the profession under the name of ortho-oxyphenyl- 
sulphurous acid, a name which at a glance is intended to make 
clear its chemical composition. F^r greater convenience it has 
been decided to call it aseptol, a name derived from its property 
of completely destroying the lower forms of life. 

Aseptol IS said to possess properties which place it far in 
advance of any thing hitherto offered for like purposes. 

It is said- to be highly germicidal, to be but feebly caustic, 
to be abundantly soluble, to possess but a slight, not disagree- 
able odor, and, so far as experiment has gone, to be far less 
toxic than carbolic acid. To this last body it stands related in 
a chemical as well as germicidal sense, and is applicable to all 
the uses to which it is put. Furthermore, owing to the greater 
solubility and the comparative innocuousness of the aseptol, it 
will find many uses where the other body for obvious reasons, 
is wholly inapplicable. 

Aseptol is described as being a viscid liquid of a slightly 
red color and of a specific gravity of 1.450; its odor suggests 
that of carbolic acid, out it is far more agreeable. It is sup- 
plied by Merck in a solution containing thirty-three and a third 



THE FEMALE URETHRA. 185 

per cent, of the substance, and in this fomi it is eligible for 
immediate use or for dilution to any desired strength. From 
the report of Drs. Leroy and Von der Shriek, of Antwerp, who 
studied quite extensively its therapeutic applications, tne fol- 
lowing table of advantages is derived : 

(1) It is very soluble in water. 

(2) It is very slightly caustic. 

(3) It is free from irritating qualities, and may be applied 
for a long time to the skin, the eyes, the bladder, etc. 

(4) Finally from its slight toxicity, which permits its use 
internally in considerable doses, and also the application of it 
in concentrated solutions to diphtheritic pharyngitis, and 
laryngitis, we anticipate for it a very wide fiela of usefulness. — 
Medical News. 



THE FEMALE URETHRA. 



For several years the attention of anatomists and sui^eons 
has been frequently directed to a pair of ducts, one on each side 
of the female urethra. They appear to be almost if not auite 
constant, and, morphologically speaking, they were hailea on 
their discovery as positive proof of the existence of the eflFerent 
duct of the Wolffian body in woman. Coblenz and others have 
frequently traced Gaertner's ducts in domestic animals, from 
the parovarium to the walls of the urethra. Klocks, Klein- 
waechter, and especially Skene, of Brooklyn, all describe the 
ducts found in the urethra of the human female. They appear 
to be subject to a localized catarrhal affection, and to be fre- 
quently involved in urethritis. Boehm, of Vienna, and several 
French surgeons have described this affection, and recommend 
the introduction of a probe coated with nitrate of silver when 
the discharge becomes chronic, the ducts being laid open if that 
treatment fail. Recently Dr. Max SchuUer, of Berlin, has pub- 
lished the results of a series of dissections, and his conclusions 
tend to subvert the theories of Skene and the morpholo^sts, 
the ducts appearing to be the outlets of a distinct pair of 
glands. Dr. SchuUer states that between the longitudinal folds 
of mucous membrane that converge toward the meatus, numer- 
ous pores and depressions may be found. On each side of the 
midale line posteriorly rises a ring of mucous membrane sur- 
rounding an orifice, into which a sound of from one to four 
millimetres in thickness, can be passed from half a centimetre 
to two and a half centimetres upwards. This is the duct, and 
the pair have been found by Dr. SchuUer in subjects of every 
age from fetal life to the eightieth year almost constantly. 
Inflammation of the urethral ducts can be diagnosed when dis- 
charge from the meatus exists, without scalding pains during 
micturition. On horizontal section the duct appears as a slit, 
with a contour the more and more irregular from involutions 



186 EXAMINATION IN COXITIS— ANTIPYRIN. 

and elevations of its lining membrane, the higher up the sectioi^ 
is made, antil it can be traced to its termination above as a 
gland made up of a collection of short tubules. The orifice of 
the duct is lined with a thick layer of squamous epithelium 
covering erectile tissue, the rest of the canal is covered with 
stratified transitionid epithelium, covering vascular submucous 
tissue that contains plain muscular fibres. In old subjects the^ 
ducts are much contracted. Dr. Schuller has traced Uieir origin 
in the fetus to the same period of embryonic life as that wherein 
the other structures composing the urethral mucous membrane 
are developed, and he can find no communication between 
them and the ducts of Oaertner. — British Medical Jotcmcd, 



EXAMINATION PER RECTUM IN COXITIS. 



This method of examination is recommended by Carin 
(Arch.f, Kinderh.^ Band V, Parts III and IV) in inflammatory 
conditions of the hip-joint, as well as of the pelvic bones, as a 
means of especial value in the period of childhood. Either the^ 
dorsal or the knee-elbow position may be chosen, the most 
important structures in and about the pelvis being easily acces- 
sible to the examining finger. The author recommends, how- 
ever, the dorsal position when the right hip-joint is diseased, 
and the knee-elbow position when the disease is in the left side. 
[It seems hardW necessary to direct, as the author does^ that 
the examining finger should be well greased, and slowly intro- 
duced into the rectum]. The disengaged hand may be placed 
upon the abdomen, and may assist the examining finger in 
confirming its discoveries. Several cases of acetabular disease 
have been diagnosticated by the author by this means. His 
conclusion is that all cases of coxitis should be investigated 
per rectum, but especially those in which resection is to be 
performed. — Archives of Pediatrics. 



ANTIPYRIN. 



In a recent paper in the Medical News, Dr. H. C. Girard gives 
an account of this agent. It is a product of coal tar and was 
first prepared by Dr. Knorr, of Erlangen. Chemically it is a 
dimethyloxychinin. Occurring in commerce as a muriate, it is 
a grayish white crystallized powder, with a weak, tarry odor, 
and somewhat bitter, but supportable, acrid taste. It is easily 
soluble in alcohol and in less than fifty per cent, of lukewarm 
water, from which it deposits very slightly on cooling. Its 
preparation and chemical composition are a secret, and are 
patented in Germany. 

Professor Filehne, of Erlangen, was the first to introduce this 
drug into medical practice, and almost uniform testimony has- 



INCONTINENCE OF URINE IN CHILDREN. 187 

been now borne to its efQcacy. In high fevers it has been 
found to redace the temperature without evil results. It has 
not, however, seemed to shorten the diseases for which it was 
given. 

It may be administered by the mouth or rectum or hypo- 
dermically ; the latter being on some accounts preferable. 

Filehne advises to give in the afternoon thirty grains to be 
followed by hourly doses of fifteen grains till the aesired reduc- 
tion of temperature is obtained in cases of pronounced fever* 

It is more soluble than quinine and acts efficiently in some 
cases where the other drug nas no favorable effect, even in large 
doses. 

The only evil effects observed have been the production of 
an exanthema in a few cases or slight vomiting. Collapse 
occurred in one case of a child two and a half years old who 
was suffering from typhoid fever and to whom two hourly doses 
of four grains each had been administered. In one or two other 
cases some degree of collapse has been observed, and it will be 
well to be cautious in its administration, especially in cases 
where the action of the heart is feeble. 

The remedy seems to have been demonstrated to he of real 
value, but further clinical experience is necessary in order to 
determine its scope and field of usefulness. — Courier of Medicine, 



INCONTINENCE OF URINE IN CHILDREN. 



Dr. S. S. Adams divides cases ot this sort into three classes. 
Patients of the first class suffer from a constant dribbling night 
and day. These cases are rare and are usually associated with 
some serious pathological state. In the only two cases of this 
class which he has met vesical calculus was found in each case. 

In the second class the incontinence is intermittent and 
occurs by day as well as by night. The urine is retained for a 
time, but when the desire to urinate comes it is imperative, and 
before the child reaches a convenient place the sphincter 
relaxes and the child cannot control the flow. This is the 
most common form with girls, and is generally due to vulvitis 
or urethritis caused by irritation from ascarides in the vagina. 

The third class includes the more common cases of both 
sexes, who, during profound sleep, generally about midnight, 
urinate in bed. Patients of this class generally dream of urin- 
ating. Dr. Adams thinks that the vesical incontinence of child- 
hood is analogous to seminal emissions from the adult male, in 
each case the discharge being the result of a conservative pro- 
cess of nature to relieve irritation. 

In some cases the incontinence depends upon phimosis, and 
is cured by circumcision. When due to vesical calculus, of 
course the removal of Ihe foreign body is imperative. 

While chloral has been highly recommended by some. Dr. 



188 NIQHT TEBR0R8 IN CHILDREN. 

Adams regards it as dangerous and uncertain. The bromides 
rank first in the treatment of cases due to exalted nervous con- 
dition and should then be given in large doses at bed-time. 
Belladonna he regards as the remedy par excellence for cases 
associated with tonic vesical spasm. It should be given at bed- 
time in large doses, to be increased a drop at a dose until either 
relief is attained or physiological effects are produced. Children 
tolerate relatively larger doses of belladonna than adults. 

Strychnia wuuld be indicated if there were relaxation of 
the sphincter vesicae, or paresis of the muscular walls of the 
bladder. 

Attention must be paid to general condition, diet and 
hygiene if success is to be attained. — Courier of Medicine, 



NIGHT TERRORS IN CHILDREN. 



The picture which a child suffering with this condition pre- 
sents, is somewhat as follows (Moizard in the Re8. mens, des 
Mai. de VE.) : The child, say from three to six years of age, 
has gone to sleep apparently in his usual health. Two or three 
hours later he suddenly rises up in bed, with hir eyes wide open, 
and evidently fixed upon some terrifying object; this may be 
to his imagination a monster, robbers, etc. His cries are pitiful, 
his words incoherent, and he fails to recognize friends wno are 
around him. This condition may last from five minutes to half 
an hour; then comes a period of calm, he falls asleep again, 
and the next dav is as well as ever, without recollection of the 
■experience of the previous night. No convulsions hjive ever 
been observed as accompaniments to it. West related the case 
■of a child, eleven months old, which was troubled with gastro- 
intestinal disease attributable to dentition, who was in the habit 
of having seven or eight attacks in a single night. The accident 
usually happens several nights in succession, during a period 
■of five or six weeks, and cases are related in which it has 
■continued during a much longer period. The phenomena of 
somnambulism are sometimes observed in connection with this 
condition. It usually occurs in nervous, impressionable chil- 
dren, and very often in those whose constitutions are weak, or 
who have been brought up in defiance of the rules of hygiene. 

The author divides the sufferers into two classes, according 
as there exists or does not exist a permanent lesion of the brain. 
In the latter class the most frequent cause of the trouble is to 
be found in disturbance of digestion. This reflex disturbance 
of the cerebral circulation is believed to be more frequent in 
children than in adults, and this, notwithstanding the fact that 
incomnia, somnolence, vertigo, vasomotor disturbances, hys- 
terical and other morbid phenomena, are well-known results of 
digestive disorders in adults. The morbid action is directed 
upon the v^i so-motor nervous system, and the author mentions 



EFFECTS OF OXYQEN AND OF OZONE. 18& 

as causative elements too much or too exciting food^ too much 
alcoholic liquor and constipation. As to dentition, night terrors 
are much more frequently observed during the first than during 
the second dentition. Less frequent causes are intestinal worms, 
the irritation of certain skin diseases, and the absorption of 
certain drugs — ^belladonna, stramonium, and quinine beine^ 
mentioned as examples. In the other class, in which cerebral 
lesions form an exciting cause, night terrors may be a prelim - 
inarv indication of tubercular meningitis, cereoral sclerosis, 
cerebral tubercles, epilepsy, and hysteria. 

The prognosis is usually favorable excepting in cases in 
which severe cerebral lesions are present. 

The treatment should vary in accordance with the deter- 
mining cause. Certain hygienic precautions of both physical 
and intellectual character snould be observed in all cases. All 
cerebral excitement must be avoided, whether it be caused by 
the reading of fascinating books or by listening to stories of a 
terrifying character. The subject should not be left alone in 
his bedroom, and when an attack comes on he should be 
soothed and sympathized with. Regular and healthful exercise 
should be insisted upon and the diet should be light and unir- 
ritating. If dyspepsia co-exists, alkaline preparations, pepsin^ 
or the tincture oi nux vomica may be given. West is in favor 
of suitable doses of bromide of potassium and chloral for a 
calmative effect upon the nervous system. Quinine is also rec- 
ommended as a useful drug in many cases. If the gums are 
hot and swollen it will be eminently proper to relieve them by 
incision. — Archives of Pediatrics, 



THE THERAPEUTIC EFFECTS OF OXYGEN AND OF OZONE. 



It is a popular error that breathing pure oxygen would prove 
destructive to animal life by greatly accelerating combustion in 
the body as it does of the fuel of an ordinary fire. Filipow has 
lately submitted the question of the physiological action of 
oxygen and ozone to exact experiment on men and dogs; his 
results {Pfiager's Archiv, Band XXXIV, seite 335) may be 
summed up as follows: (1) Breathing pure oxygen is followed 
by no effects which distinguish its action from that of pure 
atmospheric air, at least as regards pulse, respiration and body 
temperature. (2) In cases of poisoning with chloroform, alco- 
hol, sulphuretted hydrogen or carbonic oxide, respiration of 
pure oxygen offers no advantages over that of pure air. (3) 
breathing in diluted ozone is without the narcotizing effects 
which some ascribe to it. (4) Respiration in concentrated 
ozone produces powerful irritation of the mucous membrane^ 
and is therefore injurious. (5) There is no proof that ozone is 
taken into the blood through the lungs. — American Naturaiisty 
January, 1885. 



190 AMENORBH(£A — MISCELLANEOUS ITEMS. 

TREATMENT OF AMENORRHCEA BY PERMANGANATE OF 

POTASH. 



Drs. Ringer and Murrell have used the permanganate of 
potash in sixty-nine cases of amenorrhoea in solution and in 
pills, beginning with a dose of six centigrams three times a 
day and increasing it progressively to twelve centigrams. This 
treatment has given excellent results in young girls who were 
affected with amenorrhoea from taking cold. The treatment 
should be commenced several days biefore the time for the 
appearances of the menses. The results of this treatment have 
been no less satisfactory in women from thirty-five to forty 
years, in whom the amenorrhoea was symjptomatic of repeatea 
confinements and prolonged lactations. On the other hand, if 
the amenorrhoea is in consequence of normal pr^nanc^, the 
treatment is perfectly inoffensive. It remains inert if the 
amenorrhoea occurs in the last stages of phthisis. In the first 
stages of phthisis, the permanganate may cause the menses to 
reappear^ but it has no influence on the progress of disease. 
Finally, m young girls where the establishment of the men- 
strual period is regarded, it has but little effect. — Journal of the 
American Medical Association. 



MISCELLANEOUS ITEMS. 



Deep snoring, and an insensitive conjunctiva, are good signs 
of insensibilitv, but the most trustworthy one of all, subsultus 
tendinum of the fingers. — Medical Review. 

Dr. F. M. Jennings, of Harwood, Missouri, says he has used 
papine in his practice, during the last year, in many cases, and 
invariably, where indicated, found it as represented. In fact 
all of Battle & Co.'s preparations, in his hanas have given entire 
satisfaction. 



Iodoform in Organic Diseases of the Heart. — Prbfessor 
Testa, of Messiana, has employed with success the treatment 
recommended by Moleschott for the relief of functional disturb- 
ances in incurable disease of the heart. This consists in giving 
seven centigrams of iodoform in four pills daily, continuing it 
for some time, this lasting in one patient for nearly a month. 
It acts especially by diminishing the number of the beats of 
the heart and increasing arterial tension. — Oazette des HSp.: 
Medical Times and Oazette, 



Making a patient keep his eyes closed while recovering 
from the ether is a great aid in preventing illness: for, owing to 
the patient feeling giddy, any object at which he looks appears 



MISCELLANEOUS ITEMS. 191 

to sway from side to side; and this, by itself, is sometimes 
-enough to produce a feeling akin to sea-sickness, even in those 
who have not been anaesthetized. — Medical Review, 



If we wish U) avoid sickness after anaesthetics, it is of the 
utmost importance that the patient should not be shaken when 
being lifted from the operating table to the bed; and if the 
operation has been performed on the bed, then the bedstead 
should be allowed to remain without bein^ moved in the least 
for four hours, as the slightest movement is sometimes enough 
to start the vomiting. — Medical Review. 

Various writers and travellers have mentioned the use and 
influence of coca. Of it Cowley writes : 

"Our varicocha first bis coca sent, 
Endow'd with leaves of wondrous nourishment, 
Whose juice suck'd in, and to the stomach ta'en, 
Long hunger and long labor can sustain ; 
From which our faint and weary bodies find 
More succour, more they cheer the droopins mind. 
Than can your Bacchus and your Ceres joined. 
Three leaves supply for six days' march afi^ord ; 
The Quitoita with this provision stor'd, 
Can paas the vast and cloudy Andes o'er.'' 

New Symptom op Locomotor Ataxia. — Dr. Althaus calls 
attention to a symptom of locomotor ataxia which has not before 
been noticed by medical writers. In addition to the usual tests 
of watching the patient get up from a chair or couch, making 
him stand with his feet close together, or on one leg with closed 
eyes, making him turn around quickly, or go down stairs, in 
which movements certain peculiarities will be noticed betraying 
locomotor ataxia, he states that at an early period patients find 
it impossible to walk backward. Sinc^e his attention was first 
callea to this matter he has made the test in every case that 
has come under his observation, and has found the symptom 
present in nearly all of them. — British Medical Journal. 

Standard Disinfectant. — Dr. Geo. M. Sternberg suggests 
the combination of the permanganate of potassium with the 
bichloride of mercury for common use as a disinfectant and 
deodorizer for the purpose of disinfecting sputa of diphtheria or 
tuberculous patients and liquid feces of cholera, typhoid fever, 
etc. The intense color of the permanganate would be a safe- 
guard against the solution being accidentally drunk and at the 
same time this salt has decided deodorizing power while at the 
same time the stronger disinfectant properties of the mercuric 
salt would be utilized. He suggests a solution of two drachms 
of each of these salts in a gallon of water as an appropriate 
strength for domestic use. — Medical News, January 10, 1885. 



192 MISCELLANEOUS ITEMS. 

Disinfectants for Clothing. — In cases of small-pox, yellow 
fever, and some other contagious diseases, the clothing and bed- 
ding used b^ the patient while sick should be burued. In 
other cases, it may be disinfected by thoroughly baking in an 
oven. Beds should be thoroughly disinfected after every case 
of contagious disease. The National Board of Health recom- ' 
mended a few years ago, for clothing, a solution made of four 
ounces of zinc sulphate and two ounces of common salt, to the 
gallon of water. The solution should be made boiling hot, and 
after the clothes have been placed in it, piece by piece, it should 
be kept boiling hot until it has permeated every portion of the 
clothing. If nothing else is possible, clothing which has been 
exposed should be thoroughly boiled before being used again. — 
Druggists^ Qlrcular. 

The Preparation of Liebig's Food. — Dr. E. T. Williams in 
the Boston Medical and Surgical Journal of November 13, page 
460, says : " The earliest announcement of Liebig's method of 
preparing infant's food was received with the warmest enthusi- 
asm by the profession and the public. . The idea of using malt 
as an artificial digestive for starch was certainly a brilliant one, 
and seemed to promise an infallible cure for every form of 
starchy dyspepsia, both in children and adults. The notion of 
a manufactured Liebig's food prepared to hand and ready for 
Xise was a natural conception and nas much in its favor. This 
does away with the trouble of cooking, and secures a perfectly 
uniform product. One of Liebig's sons, with the *help and 
approval of his father, as he states, is or was concerned in the 
manufacture of such an article under the name of an extract of 
Liebig's food. Similar preparations have been sold in England 
and America. They are made or should be made by digesting 
malt and water in the form of a *mash,' as brewers do, till the 
starch changes to glucose, and then evaporating to dryness in a 
vacuum. They are nothing more than Liebig's rood ready-made 
and evaporated down for convenience of keeping and dispens- 
ing. The popular Mellin's and Horlick's foods are articles of 
this sort. They consist mainly of grape sugar with the nitrog- 
enous and mineral elements of grain. A half-pound bottle of 
Mellin's food costs seventy-five cents; a one pound can of Hor- 
lick's food sells for the same price. They are good foods and 
suit children extremely well. Liebig recommends the food as 
a nutritious drink for adults as well as children. Its suitability 
for invalids and convalescents, for nursing mothers, and starchy 
dyspeptics goes without saying. Liebig recommends it in coffee 
in the place of cream. I have found it very good in chocolate. 
With coffee especially, in the style of cafe au lait, I have found 
it a capital breakfast drink. I think that both coffee and cho- 
colate a la lAebig, if they could be made fashionable, would 
make a most useful addition to our dietary." 



THE 



PHYSICIAI AP SMGEOS 

A MONTHLY MAGAZINE, 
DEVOTED TO MEDICAL AND SURGICAL SCIENCE. 



Volume VIL MAY, 1885. Number V. 



ORIGINAL ARTICLES, 



CASE OF DISEASE OF THE RIGHT OVARY: OBESITY; DEATH ; 

POSTMORTEM. 



BY JOHN W. HANDY, M. D., Hartland, Michigan. 



The following case,^ recently occurring in my practice, is^ 
regarded of sufficient interest and importance to be placed orfe. 
record. * 

On Sunday, April 5, 1885, 1 was called to see Mrs. A., aged* 
fifty-two years. To be of fair proportion the patient should 
have weighed not more than one hundred and thirty pounds,, 
but there was such an enormous amount of fat deposited on 
her body that she weighed over two hundred and fifty pounds. 
The messenger having informed me of the patient's suffering,. 
and not being able to return with him, I sent two of Brown- 
Sequard's pills to be taken immediately on his arrival home.. 

When I saw the patient, several hours after, about 3:30 p.. 
M.9 she was free from pain and was sitting in a chair. This was^ 
the first ease she had had since early the preceding evenings 
During this period she had complained of severe pain in the 
region of the right ovary, which extended along the course or 
the right Fallopian tube. At times the pain would increase in^ 
severity and become lancinating in the region of the uterus. 
Pulse, 83, and temperature, 100 4-5°. The bowels had not 
moved since the morning of the day preceding my visit. The^ 
tongue was coated with a heavy, brownish fur. Breath fouL 
No desire to take food. 



194 DISEASE OF THE RIGHT OVARY. 

She had been subject to such attacks. They had been 
coming on quite frequently, but were not as severe as this last 
one, and would pass off without treatment. These attacks 
seemed to be caused by exposure to cold or from overwork. 
The day previous to this attack she had ridden some miles 
over a very rough road. Soon after her return the pain 
began and had continued, steadily increasing in severitv. I 
left her more anodyne medicine to be taken to control the 
pain and a powder containing six grains of pulverized blue 
mass to be taken that night with instructions to have a saline 
administered the following morning. 

The patient wtis again seen April 6, at 1:30 p. m. The pain 
was not so severe, and she had been able to sleep some through 
the night. She had, however, not gone to bed, but spent the 
night in a chair. The pulse 80 ; temperature, 100 3-6°. Bowels 
had not moved. The pain had extended more generally over 
the abdomen. There was some tenderness on pressure, but it 
was not very marked. While the pain and tenderness was 
attributed to the sensitive and probably slightly inflamed 
peritoneum, I judged it safe to persevere and move the bowels, 
as the saline did not seem to give any increased pain. The 
dose was ordered to be repeated, and if the bowels did not 
respond within three hours a third dose to be administered. 
The use of anodynes to be continued as might be required to 
control the pain. 

The patient was seen again at 10:30 of the morning of the 
next day. Pulse, 86; temperature, 101 1-5°. The saline, which 
had been repeated, was followed in about one-half hour, by a 
very free movement. The dose of saline that was given this 
morning was not retained on the stomach, but a second dose 
occasioned no discomfort and produced two copious dis- 
charges, which were quite fetid. The patient was comfortable 
and had rested much better through the past night than the 
previous one. She was comparatively free from pain except 
when she moved about. The temperature having gradually 
increased, she was given fluid extract veratrum viride, two 
drops, and tincture aconite root, one drop, to be taken every 
two hours. Sulphate of quinine was oraered to be taken in 
four grain doses every four hours until sixteen grains were 
given. A sinapism was put over the abdomen, and instructions 
for the saline to be given in the morning. 

April 8, 2 p. M.: The patient feels quite well. The pain has 
nearly all disappeared. She complains of soreness of the abdo- 
men, but it is principally external and superficial. Quite firm 
pressure over the right ovary produces no discomfort except a 
sense of su perficial soreness. The tongue is cleaning up, and 
the appetite, which had been greatly impaired, is much 
improved. The bowels readily respond to light doses of saline 
mixture. Pulse, 74; temperature, 100 4-5°. Tincture of aeon- 



DISEABfi OF THE BIGHT OVARY. 195 

ite, in two drop doses, every three hours j sulphate of quinine, 
three grains every three hours, and a sahne to be taken in the 
morning, were ordered with instructions to inform me if the 
patient did not steadily improve. The case was discharged. 

The husband called and reported that the patient had been 
able to lie down and had rested well during the night. A gentle 
movement of the bowels followed the saline in the morning. 
She felt very much better, and could go about the house feeling 
no pain upon making any movements of her body. She took 
her medicine through the day, and was able to do a few house- 
hold duties. Her appetite had returned, and after eating 
supper she expressed herself as ^' feeling well," and said that she 
" would retire early as she expected to nave a eood night's rest, 
as she felt as well as she ever did in her life." She retired 
about 8:30, and after both had fallen asleep the husband was 
awakened about 10:30 by a strange sound like a person strug- 
gling for breath. He immediately raised her up in bed, but he 
could not feel any pulse or detect the beat of the heart. He 
dashed water on her face, but she breathed only a few times 
and sank without a word or a struggle. 

I examined the body but coula discover no external signs 
of the cause of death. The privilege of making an autopsy was 
freely granted me, and in company with Dr. McHench, of 
Brighton, a postmortem examination was made. Supposing 
death to have resulted from failure of heart action, that organ 
was first examined. It was found in diastole and all the cavi- 
ties filled with blood. The walls were very thin and soft. The 
finger passed through its structure upon the slightest pressure. 
The peritoneum over the entire abdomen was covered with 
inflamed spots and rough patches, showing the extent of the 
recent peritonitis. The right ovary was enlarged, and cystic. 
The cyst was dermoid in character. The pedicle which was 
about five inches long was twisted in such a manner as to pro- 
duce strangulation of the growth. The walls of the cyst were 
dark in color and much congested. On being opened it was 
found to contain some solid materials, which proved to be 
masses of pure fat, and balls of hair matted together with fat. 
Some of the hairs composing one of the bodies measured fifteen 
inches in length. The center of the cyst was filled with a 
creamy fluid', which was only liquid fat. The two masses of fat 
accurately fitted the two ends of the elongated cyst, and it 
seemed as if the whole tumor had been a solid mass, but that 
the high temperature, and inflammatory action in the parts had 
caused the center of it to become fluid in character. The 
inflammation doubtless began in the pedicle at the point of 
strangulation, which was attached to the middle of the irregu- 
larly oval cyst. When the contents of the cyst were removed its 
capacity was found to exceed two and one-half pints. The 
microscopical examination of the cyst fluid showed it to be 



196 VIENNA SURGERY* 

chiefly oil globules and flat epithelial scales. The structure 
of the heart was not examined but from its appearance, there is 
no doubt that the muscular tissue had undergone fatty degen- 
eration. Four lar^e calculi were found in the gall bladder, the 
largest about the size of a hickory nut. 

Except when sufiering from these attacks of pain in the 
ovaries and uterus, there had never been any symptoms of car- 
diac disease. As all the other organs of the body were healthv, 
there is no doubt that death resulted from failure of the greatly 
weakened heart. 



GENERAL CORRESPONDENCE. 



VIENNA SURGERY. 



Editor of The Physician and Surgeon : Sir — The Austrian 
government which controls so absolutely every thing under its 
sway also has a strong influence on the surgery, or rather the 
surgeons, of this country, strange as it may seem to our ideas 
of individual effort ana reward. The greatest surgeons here 
can only be those recognized by the government; at least so 
far as reputation is concerned. The two university professors 
of surgery are appointed by the government, and although 
they may win their appointment oy merit, yet such is the 
power and prestige given them that outsiders can attain only 
a moderate amount of distinction. Professors Billroth and 
Albert now hold the appointment, and after witnessing their 
skillful work, no one, I think, will deny that they deserve their 
positions. 

Didactic lectures hold a very subordinate place in the teach- 
ing of surgery, instruction in this line being principally clin- 
ical. Professors Billroth and Albert each hold a clinic daily 
five times a week, commencing at 10 a. m., and lasting until 12 
or 1 o'clock. If any out-patients then r^tnain they are attended 
to by their assistants, which often prolongs the clinic an hour 
or so more. Professor Albert, while performing equally serious 
operations, makes his instruction rather more elementery than 
Billroth, and his clinics are consequently crowded by the 
younger students, while the more advanced men and foreign 
visitors prefer Billroth, who assuredly possesses a much wider 
reputation. 

They each have about ten assistants trained for special 
duties, thus one attends to the dressings, another to instruments, 
another to sutures anc) ligatures, etc. The "first" assistants 
stay with their professors about four years, and are themselves 
somewhat eminent, and are excellent surgeons. They, and not 
the professors themselves, give the private courses which attract 
foreigners. 



VIENNA SURGERY. 197 

With such assistance it is easy to comprehend that bolder 
operations may he attempted than if the operators were poorly 
supported. Another fact which I think prompts to boldness 
or even recklessness, is the complete power over the patients 
given by the same governmental authority. The hospital is 
entirely under this control and patients entering it sign a paper, 
I am told, giving the surgeons liberty to use their own judg- 
ment as to the operations, etc., and the right of autopsy in 
case of fatal termination. Moreover, the surgeons being secure 
in their life positions, care less than we on the other .^ide the 
Atlantic for fatalities or adverse comment. I would not sa^ 
that these facts make them any the less careful for their 
patients' welfare, but it is the opinions of foreigners that the 
tendencv is in that direction, and this may in part explain the 
undertaking of difficult operations, where there must be some 
successes, and justify the reputation for "bold surgery," which 
Vienna possesses. I have heard Professor Braun's assistant 
tell his chief that he never asked patients whether they would 
consent to an ovariotomy or not, but that he simply told them 
the operation would be done. The spray is not used much now 
except in some case of abdominal section. Billroth uses irri- 
gation with carbolized water at intervals during the operation. 
He is opposed to the solution of bichloride of mercury used 
dsewhere, thinking it too irritating. Before every operation 
the usual antiseptic procedure of scrubbing the part with nail 
brush and shaving it is gone through with. Silx is used en- 
tirely for ligatures and sutures. The instruments are kept in 
carbolic solution and are preferably made in one piece, handle 
being the same as the rest of the instrument, to avoid joints 
whicn are difficult to cleanse and liable to become receptacles 
for dirt or infection. 

Some operations are performed every day, but occasionally 
Professor Billroth consumes considerable time lecturing on 
cases. He illustrates by blackboard to a great extend, and 
being an accomplished artist he renders his points very clear. 
Two operations devised by him are perhaps the best known in 
America of any of his and have contributed most to his repu- 
4;ation there. I refer to the resection of the stomach and 
removal of enlarged thyroid gland. He takes the utmost pains 
in both, and while he often allows his assistants to do opera- 
tions he has never been known to allow them to do these 
except in one instance, where Dr. von Hacker, his first assist- 
ant, resected a pylorus. 

An account of one case of each may not be uninteresting 
to your readers. 

A patient, male, aged about forty-five years, pale and ema- 
ciated, was brought in with carcinomlEL of the pylorus and 
adjoining extremity of the stomach. An incision was made 
in the median line and slightly enlarged laterally by a cut at 



198 VIENNA SURGERY. 

right-angles to it. Every bleeding point was tied and the 
wound made perfectly dry before proceeding further. The 
anterior wall of the stomach was then brought into the wound 
and an oval piece removed, at a point free from disease, great 
care being taken to stop all bleeding. Then the duodenum was 
taken up at a point about twelve inches from the pylorus and 
a corresponding oval portion removed. The edges of these two 
openings were then approximated and carefully sutured, thus 
making an opening from stomach to intestine at a portion free 
from disease. The stomach was then brought forward again 
and a section completely across it was made very slowly and 
carefully above the carcinoma but beyond the junction with 
duodenum just made. The cut edges were then brought to 
each other, completely closing this pyloric end of the stomach 
making of it a blind pouch. A similar section across the 
duodenum below the seat of the disease but above the opening 
of the bile-duct was then made and the end closed as in the 
case of the stomach. Thus the diseased portion was removed 
and there remained two blind pouches, namely, pyloric ends of 
stomach and duodenum. The continuity of tne alimentary 
canal was preserved by the first mentioned opening from ante- 
rior wall of stomach to healthy duodenum. The portion of 
intestine above this latter onening now was nothing more or 
less than an enormus bile-auct. The abdominal wound was 
closed with silk and the usual antiseptic dressings applied. 
The patient rallied promptly and at the end of eight days, 
when I last saw him, was doing very well, taking milk, cham- 
pagne, etc., and gaining in strength and color, with every pros- 
pect of recovery. He had no rise of temperature after the first 
day or two and the external wound was healing fast. 

The case of enlarged thyroid gland was in a middle-aged 
woman, fairly healthy. The growtn was largest on the left side 
and so compressed the trachea that breathing was difficult. 
An incision was made over the most prominent portion on the 
left side down to the gland and after this the knife was used 
but very little. The tumor was dissected up with fingers and 
handle of scalpel, and every portion of tissue raised was ligated 
by aid of an aneurism needle in two places, and the mter- 
vening band severed with scissors. This mode of operating 
though slow, made an almost bloodless operation, and at no 
time was the scene of operation obscured by haemorrhage. 
The gland was followed around in front of the trachea and to 
the right side. It was found to project backward even behind 
the oesophagus, but was all successfully removed by this mode 
of ligating and cutting. The wound was dressecl as usual, 
with a drainage tube projecting from its lower angle, and the 
patient made a good recovery. 

Dr. a. W. Hurd, of Detroit. 

ViZNNA. March 25, 1885. 



MICHIGAN STATE BOARD OF HEALTH. 199 

MICHIGAN STATE BOARD OF HEALTH. 



The annual meeting of the Michigan State Board of Health 
was held at its office in Lansing, Michigan, April 14, 1885. 

The members present were John Avery, M. D., President; 
Arthur Hazlewood, M. D., C. V. Tyler, M. D., Professor V. C. 
Vaughan, M. D., and Henry B. Baker, M. D., Secretary. 

This being the annual meeting, the President's address was 
the first order of business. The President said that he had pre- 
pared no formal address. He thanked the members for the 
many courtesies shown him during his administration. He 
had no change of policy to recommend to the Board ] no marked 
change, he thought, is desirable. The work is well understood, 
and is in a satis&ctory condition. The Board must be governed 
somewhat by emergencies, asibhey arise. He could congratulate 
the Board on what it had achieved. He thought it would be 
wise to continue holding sanitary conventions in dififerent 
places in the State. He spoke of the probable advent of Asiatic 
cholera, and thought that it might tax the Board to its utmost. 
The Board had done all it could to prepare to resist the disease, 
but should be ready for further action. If the bill before the 
legislature becomes a law, the duties as well as the powers of 
the State Board of Health to prevent and restrict that disease, 
will be increased. It would be desirable to continue to advise 
police regulations in cities, adapted to preventing unsanitary 
conditions and the introduction or spread of cholera; and the 
health officers of cities, villages' and townships of the State, 
especia'ly as they are just now being changed, many being 
entirely new in that office — should be instructed in regard to 
their duties. 

The Secretary read a report of the work of the office during 
the past quarter. Of the seven hundred and sixty pages of 
copied letters sent out, one hundred and fifty-three pages were 
modified circular letters to local health officers, in regard to 
prompt action to restrict contagious diseases. In connection 
with those, about ten thousand copies of the documents on the 
restriction and prevention of certain contagious diseases, and 
on the duties of health officers, have been sent to health officers 
for distribution to neighbors of families in which such con- 
tagious diseases have been reported. Since the last meeting of 
the Board, the outbreak of small-pox at South Boardman had 
been suppressed. During the past quarter there had been one 
case of small-pox at East Saginaw, two cases in Grand Rapids 
(confined to one house), the first of which was a commercial 
traveler who thinks he was exposed on the train between Bos- 
ton and Grand Rapids. About the time he was exposed it is 
known that a man having small-pox passed through Michigan, 
on the Michigan Central railroad, from Ontario to Chicago, en 
route for Manitoba. At Battle Creek there have been four cases 



200 MICHIGAN STATE BOARD OF HKALTH. 

with one death from small-pox, the contagium of which is sap- 
posed to have come from a brakeman on the Chicago and 
'Grand Trunk railroad, who stopped with a family in Battle 
'Creek while he was slightly sick, and who thinks he contracted 
•the disease on the train near Chicago. Two members of this 
family in Battle Creek visited friends in Bellevue, in Baton 
•county and emall-pox broke out in the family in which thtjy 
:8topped. Five cases and one death have occurred there; biit 
thus far the disease at Bellevue has been confined to the one 
family. All the members of the family were vaccinated with 
Tims on points from Fond du Lac, Wisconsin, as soon as it was 
(known they had been exposed ; but in three cases the vaccina- 
^on did not work. In one case in which the vaccination 
worked, the person has shown no symptoms of the disease. 

At tne last meetins; of the Board, the subiect of proposed 
legislation relative to diseased animals, and relative to a stand- 
ard for milk, had been referred to the committee on Wislation 
:and diseases of animals jointly. The secretary reported consid- 
erable time and care had been devoted to the perfecting of 
three bills relating to those subjects, which had been introduced 
into the house of representatives this session. 

DANGEROUS ILLUMINATING OILS. 

The Secretary reported that during this session of the le^- 
lature there had been considerable lobbying to get the legisla- 
ture to lower the standard test for dangerous oils, and to do 
away with the use of the tester adopted and recommended by 
this Board. The claim of the lobbyist, who came to this office, 
was that the change was wanted in the interests of manufactur- 
ers of small quantities of oil who, he claimed, could not now 
compete with the Standard Oil Company. Just how lowering 
the test would favor those particular oil manufacturers more 
than it would the Standard Oil Company, he did not make 
clear. It has been rumored here that the reason for changing 
^m the tester now used, was to enable a dealer in a patent 
^apparatus to sell his tester* but as this changejs advocated b^ 
ithe same person who is laboring for a lowering of the test, it 
rseems more reasonable to believe that the main reason is that 
tthe proposed apparatus does not detect the explosive vapor at 
ieo low a degree of temperature as does the present tester. From 
^experiments it seems that simply by the proposed change in 
the tester the standard would be lowered about ten degrees. A 
•committee was appointed by the Sanitary Convention held at 
Lansing, March 19 and 20, to consider this subject. The com- 
.mittee consisted of Frank Wells (ex-president of the Michigan 
Pharmaceutical Association), chairman, H. D. Bartholomew, C. 
>E. (ex-city-engineer), and Professor David Howell, Superin- 
(lendent of Lansing City Schools. April 2, this committee went 
ibefore the Senate Committee on "State Affairs," and gave a 
verbal account of the results of their investigation, which was, 



MICHIGAN STATE BOARD OF HEALTH. 201 

in brief, that the test ought not to be lowered; that the " Foster 
Gnp " was unreliable and ought not to be substituted for the 
Michigan State Board of Health tester; that if substituted for 
the Michigan State Board of Health tester it was equivalent to 
lowering tne test by about ten degrees. 

By a vote of the Board this report concerning illuminating 
oils was ordered published, together with a resolution to the 
effect that there is not now sufficient evidence of the safety of 
such illuminating oils to warrant the lowering of the test now 
required for illuminating oils in this State. This resolution was 
adopted unanimously. 

The Secretary read the report to this Board by Surgeon 
George M. Sternberg, United States Army, now at Johns Hop- 
kins University, on his experiments on lower animals in feed- 
ing, and in making imections of culture-fluids of poisonous 
oheese with the view of learning the nature and source of the 
poison. 

Dr. Vaughan made a verbal report of his chemical experi- 
ments with poisonous cheese. He had certainly secured in a 
crystalline form a small quantity of one poison from poisonous 
cheese which would produce in man symptoms common to 
cheese-poisoning. There might be other poisons in poisonous 
cheese. He had not yet fully studied the poison he had 
obtained. It gave reactions like those of a ptomaine. It was 
probable, he thought, that butyric acid had something to do 
with the sickness caused by cheese; there are different kinds 
of butyric acid, and the absence of the odor of rancid butter 
would not prove the absence of butyric acid. 

The subject of sanitary survevs of premises in cities and 
villages was thoroughly discussed. It was thought best that 
the blanks used should be uniform, but that each city or village 
should provide its own blanks. The committee was directed 
to make a sample blank to be recommended for such work, 
and be sent with a resolution which was adopted as follows : 

Besolved, That the Michigan State Board of Health earnestly 
recommends to the boards of health of the cities and villages in 
Michigan that they make a sanitary survey of the territory 
under their jurisdiction, in blanks of which a sample is sent 
herewith ; and to adopt such measures as the sanitarv surveys 
may prove to be necessary to place the cities and villages in a 
good sanitary condition. 

Upon ballot for president of the Board for the ensuing term 
of two years, Dr. Jonn Avery, of Greenville, was re-elected. 

It was decided to demand from health officers of all villages 
weekly reports of sickness under their observation. 

Under the law requiring the approval by this Board of text- 
books on physiology and hygiene and the effects of alcohol, 
etc., before th^ are used in the schools of the State, the Board 
approved the K)llowing named book : " Elementary Physiology 



202 HEALTH IN MICHIGAN. 

and Hygiene. The Human Body and its Health : A Text-Book 
for Schools, having special reference," etc. By William Thayer 
Smith, M. D. 

The following named books were conditionally approved 
for use in the schools, with the qualification that they contained 
errors which should be corrected : 

" Practical Work in the School Room. Part I — The Human 
Body." By Sarah F. Buckelew and Margaret Lewis. 

**The Essentials of Anatomy, Physiology, and Hygiene: A 
Text-Book for Schools and Academies." By Roger S. Tracy, 
M. D. 

Dr. Vaughan reported that he had attended the meeting of 
the State Dairymen's Association at Grand Rapids as a delegate 
of the Board, and talked to the meeting on the subject of 
cheese- poisoning, especially in regard to his discovery of the 
poison. 

Dr. Vaughan also gave an account of the work of the com- 
mittee on disinfectants, appointed by the American Public 
Health Association. He is a member of the committee, and as 
such has done considerable work, and had attended a meeting 
of the committee in Baltimore. He thought the report of the 
committee when published in full would be a very valuable 
document in practical public-health work. The preliminary 
report of the committee is just published. 

Henry B. Baker, Secretary. 



HEALTH IN MICHIGAN DURING MARCH. 



Reports to the State Board of Health at Lansing, by observ- 
ers in different parts of the State, show the diseases which 
caused most sickness in Michigan, during the month of March 
(five weeks ending April 4), arranged in order of their greatest 
prevalence, as follows : (The whole number of weekly reports 
received, one hundred and ninety-six. The number placed 
after the disease is the per cent, of reports stating presence of 
disease). ' 

Neuralgia, eighty-one; rheumatism, eighty-one; bronchitis, 
seventy-three; consumption of lungs, sixty-six; tonsilitis, sixty- 
one; influenza, fifty- five; pneumonia, fifty-four; intermittent 
fever, fifty-one ; remittent fever, thirty-nine; erysipelas, thirty- 
four; diarrhoea, thirty-one; inflammation of xidney, twenty- 
four; inflammation of bowels, eighteen; whooping-cough, 
seventeen; scarlet fever, fourteen; cerebro-spinal meningitis, 
twelve; measles, nine; inflammation of brain, nine; membran- 
ous croup, nine; diphtheria, nine; typho-malarial fever, nine; 
cholera morbus, seven; dysentery, six; puerperal fever, five; 
typhoid fever (enteric), four; cholera infantum, two; small- 
pox, five-tenths. 

For the month of March, 1885, compared with preceding 



LACTIC ACID IN PATHOGENIC TISSUES. 203 

month, the reports indicate that remittent fever and rheuma- 
tism increased in prevalence. 

Compared with the average for the month of March in the 
seven years, 1879 to 1885, rheumatism and neuralgia were more 
prevalent, and intermittent fever, diphtheria, measles, scarlet 
fever, influenza and pneumonia were less prevalent, in March, 
1886. 

For the month of March, 1885, compared with the average 
for corresponding months for the seven'years, 1879 to 1885, the 
temperature was considerably lower, the relative humidity was 
more, and the absolute humidity, and the day and the night 
ozone were less. 

Including reports by regular observers and others, diph- 
theria was reported in Michigan in the month of March, 1885, 
at thirty-two places, namely, — Alamo, Armada, Armada town- 
ship, Ann Arbor, Belvidere township, Boyne, Brown City, But- 
ler township, Calumet^ Clay township. Coral, Courtland town- 
ship, Detroit, East Saginaw, Evangelme, Grand Rapids, Hast- 
ings, Hope township, Ishpeming, Ithaca, Kalamazoo, Mears, 
Montcalm township, Oshtemo, Pentwater, Pontiac, Reese, Rox- 
and township, Saint Johns, Tecumseh, Winfield township, and 
Wjrandotte ; scarlet fever at Bloomingdale, Bloomingdale town- 
ship, Charlotte, Detroit, East Saginaw, Grand Rapids, Hudson, 
Ithaca, Kalamazoo, Kalamazoo township, Leland, Ludington, 
Maple Rapids, Manistee, Muskegon, Niles, Novi, Oshtemo, Pine 
Run, Port Huron, Portland, Southfield township. South Haven, 
White Oak township, — twenty four places; measles at eleven 
places, — Brown City, Detroit, East Saginaw, East Tawas, Grand 
Haven, Grand Rapids, Ishpeming, Kalamazoo, Port Huron, 
Stanton, S wart's Creek; and small-pox at Battle Creek, Belle- 
vue, Cassopolis, East Saginaw, and Grand Rapids. 

Henry B. Baker, Secretary. 

Lansing, April 9 1886. .^_^^^__^___^_ 

ORIGINAL TRANSLATIONS. 



GERMAN LITERATURE, 
Trakblatxd by CONBAD 6B0RGB, M. D., Ann Arbor, Michigan. 



LACTIC ACID AS A DESTRUCTIVE AGENT OF PATHOGENIC 

TISSUES. 



BY PROFESSOR v. MOSETIO-MOORHOP, Vienna. 



Many experiments of the author with local applications of 
lactic acid to fungous caries demonstrated the fact that this acid 
destroys the fungous granulations with which it comes in con- 
tact in a peculiar manner, without causing the desired and 
expected decalcifying effect on the bone tissues. The applica- 



204 LACTIC ACID IN PATHOGENIC TI88UE8. 

lion of concentrated lactic acid to fungous granulations con- 
verted them into a blackish pap4ike mass. This observation 
leads the author to the thought of the practical application of 
the acid in cases of lupus vulgaries and other conglomerates of 
neoplastic infiltrations of diminished biological vitoaty. It was 
accordingly used in cases of lupus, superficial epithelioma, and 
in one case of papilloma involving the dorsum of the foot to a 
large extent. These neoplastic growths were converted by the 
concentrated acid after several hours of application into a dis- 
solved black pap-like mass, not merely cauterized and scabbed, 
thus demonstrating the fact that the pathogenic cell infiltration, 
together with its stroma and vessels, had been completely dis- 
solved and destroyed. Repeated applications enabled the total 
destruction of the neoplasm, as was evidenced by the rapid 
healing and cicatrization without interruption. In cases where 
healthy stripes and tongues of skin \fere enclosed by the neo- 
plastic growtlis, these remained unaffected from the dissolv- 
ing action of the acid. The epidermis of these healthy tissues 
appeared dissolved, but the cutis vera remained in tact. The 
biologic energy of these healthy structures is greater than that 
of the neoplasm and thus offers greater resistance to the chem- 
ical action of the acid. This property of sparing the healthy 
tissues within the area of its application renders lactic acid of 
all caustics and e^charotics especially valuable. In several 
cases of recurring lupus in which the well-known single brown- 
ish nodules appeared in the cicatrix, the acid was intention- 
ally applied to the entire cicatrix after the nodules had been 
E ricked open. The cicatrix was reddened but not destroyed, 
ut the nodules were completely destroyed, so that after the 
pap-like mass had been washed out and the parts dried, the 
empty nests of the granulations could be seen, and complete 
cicatrization followea uninterrupted under the most indifferent 
local applications. 

The results were similar both in cases of superficial epithel- 
iomas -which had progressed beyond the stage of operative 
interference, and in cases of recurrent growths after extirpa- 
tion. The author obtained healthy cicatrization in all his cases 
including that of papilloma. 

The question whether these growths recur after this method 
of treatment cannot as yet be definitely answered. If a definite 
cure can be accomplished by complete removal of the morbid 
tissues, it may also be expected of lactic acid, the action of 
which is confined to the locality. 

The author's method of application was as follows : The sur- 
rounding parts were protected by adhesive plasters, sperma- 
ceti, cerate, or fatty substances. This protection is suitable for 
avoiding an unnecessary swelling of the healthy epidermis, and 
of concentrating the effect of the acid by preventing an over- 
flow. The concentrated fluid lactic acid may be applied in 



DILATATION OF THE 8T0MACH. 205 

different ways. The simple painting of the surface is insuffi- 
cient, unless it is frequenUy repeated. A better and more suit- 
able method consists in applying to the thoroughly cleansed 
surface of the neoplasm saturated pieces of linen or wadding 
cut to fit the surface, covering these with a piece of rubber 
paper and an additional thicker layer of batting and securing 
it with a moderately tight roller bandage. The application 
should remain for twelve hours, then removed, and the part 
well cleansed with water, followed by water dressing for from 
twenty-four to forty-eight hours. The author also uses a paste 
made of equal parts of lactic acid and pure pulverized silicic 
add; this paste is spread on rubber paper appropriately cut 
and applied. The applications should not be repeated under 
twenty-four to forty-eight hours. When applied too freouently, 
especially on the face, the^ give rise to light forms of dermitis 
and oedema. Water dressings should be used during the inter- 
vals; fatty substances should be avoided for they render it 
difficult to clean the wound and prevent the action of the acid. 
The applications must be continued until the morbid tissues 
are completely removed, and when this has been accomplished 
healthy granulations will spring up under the lactic acid dress- 
ing. The action of the concentrated lactic acid is by no means 
painless, yet the pain is endurable and lasts only a few hours : 
children bear it without much crving. The resulting cicatrix 
was always smooth and soft. The author has so far cured 
several cases of lupus communis, fungus growths involving the 
skin, rodent ulcers, and the one case of papilloma. From five 
to seven applications were sufficient to accomplish the cure. 
Time — three weeks. The papilloma required a loneer time. 

This method of treatment is so far recommendaole in those 
cases of lupus in which an operation is dreaded by the patient, 
and in those sad cases of epithelial cancors which have passed 
beyond the scope of operative interference. — OentraiblaU Oe- 
sammte Medidn^ February 6, 1885. 



FRENCH LITER A TURE, 
TBAM8LATED BY E. J. WHITEHEAD, A. B., Anv Abior, Michigan. 



DILATATION OF THE STOMACH. 



Professor Bouchard found that thirty patients in one 
hundred had dilatation of the stomach; in one hundred cases 
of chronic diseases there were sixty cases of dilatation. In 
only one-third of the cases was there any trouble with diges- 
tion. In the majority of cases the disease was recognized by a 
little below the middle of a line joining the umbilicus and the 
inferior border of the lower left ribs. To have any clinical 
importance the sound should be heard when the stomach is 



206 ABDOMINAL SURGERY. 

empty. In Bouchard's opinion dilatation is the cause and not 
the result of dyspepsia. 

Dilatation of the stomach may give rise to various disorders, 
such an indigestion, congestion and tumefaction of the liver, 
causing displacement of the right kidney; derangement of the 
nervous system, changes in the constituents of the urine, cutan- 
eous eruptions, bronchitis, coryza, asthma, cardiac lesions, pur- 
pura, and rheumatism. Not all these derangements may be 
'found in the same case, but their presence, singly or together, 
justify us in recognizing various forms of the disease, according 
to the extent to which different organs are affected. There is 
also a consumptive type, characterized by general enfeeblement 
of the system. 

The first effect of dilatation is to prevent digestion and 
assimilation of food. The products of fermentation thus pro- 
duced are not only injurious but may even be actually poison- 
ous. It is to their toxic effect on the system that we should 
probably attribute the complex pathological results of gastric 
dilatation. Thus dilatation once considered a secondary phe- 
nomenon to a lar^e number of morbid conditions, is itseli the 
cause of serious diseases. — La France MSdicale. 



CLINICAL LECTURES. 



ABDOMINAL SURGERY: CASE AND CLINICAL REMARKS. 



BY PROFESSOR DONALD MACLEAN, M. D.. 
Professor of Surgery and Clinical Surgery in the University of Michigan. 

RJSPORTBD BY W. P. MUNN. " 



Mrs B., aged thirty-three years. Patient was shown to the 
class on Wednesday, April 15, 1885. She is pale and emaciated. 
Has a large and uniform protrusion of the abdomen, which 
fluctuates uniformly on palpation. Her youngest child is about 
a year old, and the tumor has grown to its present size in the 
past six months. 

The case presents difficulties of diagnosis which can be 
solved only by a careful physical examination. If the enlarge- 
ment is due to an accumulation of ascitic fluid, the bowels 
and stomach which are always more or less distended with 
flatus will float up to the anterior abdominal wall, giving a 
tympanitic note on percussion. If a cyst is present they will 
be pushed upward and backward, and the percussion note 
will be dull and flat, caused by the accumulated fluid. It is 
possible however to have the same percussion sound in ascites, 
in case there has been a previous chronic peritonitis resulting 
in adhesions or the formation of an adventitious membrane, 
binding down the intestines to the posterior wall. Such an 



ABDOMINAL ^UBGEBY. 207 

occurrence seems improbable, for the patient gives no history 
of any pain ; still it is possible that there may have been some 
peritonitis of a low form. There is no swelling of the feet, no 
kidney, Jiver or heart disease ; all of these conditions appear to 

freclude the possibility of this being an ascitic accumulation, 
t is possible that there may be a cyst of a different nature 
than ovarian, as cyst of the kidney or one of the various 
tumors to which the Fallopian tubes are liable. This, however, 
seems improbable, and my diagnosis is that it is a unilocular 
ovarian cyst, and I may attempt its removal at our next clinic, 
Saturday morning. 

Percussion gave a tympanitic sound over the natural posi- 
tion of the stomach, but a dull, flat, watery sound at all other 
positions of the anterior abdominal wall. The sound was 
slightly clearer in the right lumbar region. 

April 18 : Patient again before the clinic. Professor Maclean 
performed abdominal section, making a primarv incision in 
the median line, four inches in length, afterward increased to 
about six inches. Finding the cyst wall intimately adherent 
to the anterior abdominal peritoneum he did not attempt to 
separate it, but cut down into the cyst and evacuated a large 
quantity of fluid, mingled with pus and tinged with blood. It 
also contained several quite good sized masses of inflammatory 
material, which would certainly have rendered the operation of 
paracentesis impracticable. 

The stomach and bowels were pushed out of place by the 
cyst, which had no communication whatever with the peritoneal 
cavity, its walls being formed entirely of an adventitious mem- 
brane, composed of inflammatory new formation. No attempt 
was made to remove the cyst on account of its intimate con- 
nection with the peritoneum, but its interior was carefully 
sponged out with an antiseptic fluid and a drainage tube 
inserted. By this means the cavity can be thoroughly washed 
out every day and a re-accumulation of irritating fluid pre- 
vented. Inflammatory adhesion of the anterior walls of the 
cyst may also be stimulated by the presence of the tube. 

This cavity was really neither more nor less than an abdom- 
inal abscess, and the operation as performed was the only efiect- 
ual method of relief which presented itself, or which could 
have been of any benefit in relieving the distressing symptoms. 

I wish to note particularly that in all such cases, where 
there is an. intimate union between the peritoneum and the 
cyst walls, it is best to go right on and incise the cyst, without 
attempting to separate the two. Such an attempt in this case 
would have resulted most disastrously, for the peritoneum 
would probably have been torn through and the irritating, acrid, 
fluid contents of the cyst escaping into the peritoneal cavity 
would have caused serious, perhaps fatal, inflammation. 

Another peculiarity of the cyst was that it passed entirely 



208 ABDOMINAL SURGERY. 

above the pelvic boundaries. A catheter passed into the blad- 
der could not be felt at all from the interior of the cyst, nor 
could the point of the finger passed into the vagina be felt 
through the cyst. 

REMARKS. 

The present prognosis of the case of abdominal cyst upon 
which we operated last Saturday is favorable. The patient this 
morning was comfortable, her pulse and temperature about 
normal; their variations since the operation have been slight. 
Much is now dependent upon thorough daily cleaning of the 
cavity, and washmg out of the small pockets in it, where fluids 
may accumulate. Of course a question of much interest to us 
now is, what induced such a condition in this woman? What 
set agoing the inflammation which resulted in such a binding 
down of the viscera and accumulation of pus? And to this 
question we can only reply that we do not know. There is 
unmistakable evidence of peritonitis, although there was noth- 
ing in the history which she has given us to indicate that such 
was the case. The trouble came in such an insidious manner 
and with an utter absence of localized symptoms that it is diffi- 
cult, if not impossible, to trace it. But leaving that out of the 
question we may say that, however it may have originated, 
and however it may terminate, we have taken the only possible 
course to benefit her; we have done all that can b3 done, and 
at present I regard the prognosis as favorable. 

So far as physical examination is concerned, it is practically 
impossible to distinguish between an ovarian and an infiamma- 
tory cyst. The real question of diagnosis was the determina- 
tion of a cyst, and we did that; so that our diagnosis was 
correct. The essential facts were, first of all, the uniform and 
uninterrupted fluctuation felt all over the anterior abdominal 
wall; secondly, the dullness on percussion being almost as uni- 
versal as the tumefaction ; thirdly, there was not anasarca or 
oedema anywhere, the accumulation being confined to the 
abdominal cavity ; fourthly, the absence of any symptomatic 
visceral lesion or any rational symptom sufficiently definite to 
constitute a key to its accurate differential diagnosis, all show- 
ing, either that the cyst had grown up from the back, or that 
an inflammatory condition existed, binding down the stomach 
and bowels so that they could not move. The fact of the dull 
fluid note and not the clear resonance of a gas, was conclusive. 
Ovarian cysts are much more common in such cases, and henc» 
it was most natural to suppose that this tumor was of that 
character, but the possibility of its being a kidney cyst, or of an 
inflammatory nature, you remember I called your attention to 
before the operation. 

In connection with the operation of abdominal section for 
the evacuation of this cyst, I wish to call the attention of the 
class to some of the more modern views on this class of opera- 



ABDOMINAL SURGERY. 209 

tions, and I quote from the Medical News of April 18, 1885 r 

'^ At a recent meeting of the Royal Medical and Chirurgica) 
Society, the proceedings of irhich may be found in the British 
Medical Journal for March 14, Mr. Treves reported a case of a 
woman twenty-one years of age, in which the belly was suc- 
cessfully opened and freely irrigated with water, and a drain- 
age tube inserted, on account of diffuse peritonitis, the result 
of the bursting of a pelvic abscess. Mr. Marsh also read the 
notes of a case of a medical student, nineteen years of age,, 
suffering from critical symptoms of sudden and acute perito- 
neal inflammation, in which incision gave vent to about two 
pints of foeted pus. The abdomen was thoroughly washed out 
with one to sixW solution of carbolic acid, and a drainage tube 
introduced. Under subsequent injections of a solution of 
iodine, one to one* thousand, the patient recovered. 

"In the discussion which followed the reading of Treves'^ 
paper, Bryant, Thornton, Powell, Brainard, Goodhart and Mer- 
edith were in perfect accord in commending the practice car- 
ried out in the two cases noted. The conviction, indeed,, 
appears to be gaining ground that, in view of the great fatality 
of acute diffused peritonitis, and the futility of ordinary modes 
of treatment, laparotomy should be resorted to, thus placing^ 
effusion into tHe peritoneal cavity on the same footing afv 
pleural effusions. Its success in cases of peritonitis, compli- 
cated by the presence of an ovarion tumor, has long been estab- 
lished, and Mr. Lawson Tait states, in the British Medical 
Journal for March 21, that he has opened the abdomen in not 
less than forty-four cases on account of peritonitis, and that 
forty-one recovered. 

" In support of the wisdom of the practice, we may refer 
to a successful laparotomy reported by Mikulicz at the Versamwr- 
lung der Deutcher Naturforscher und Aerxte in Magdeburg, Sep- 
tember, 1884, for suppurative peritonitis, the result of a 
perforating typhoid ulcer. Krdnlein, too, has resorted to it for 
peritonitis due to perfoiation of the vermiform appendix, but 
with what result we are not informed. Indeed, we believe that 
we express the opinion of all thoughtful surgeons when we say^ 
that the operation is indicated in all cases of suppurative peri- 
tonitis from whatever cause it may arise, as well as in examples^ 
of ordinary acute peritonitis, the result of perforating lesions- 
of the stomach and intestines." 

I regard this last as a statement of a fundamental surgical 
doctrine. Perhaps it is too much to say that the whole ques- 
tion is definitely settled, but at any rate we may say that tnere 
is enough experience in regard to it to justify further trials la 
this direction. 

Let us suppose this doctrine to be established and become^ 
a rule, then m all cases of peritonitis, whether acute, traumatic 
or idiopathic, we may open the peritoneal cavity and evacuate^ 

N 



210 ABDOMINAL 8CBGBBY. 

it AS we would any other abeoesB. Thus we see a new field 
opening up in surgery. Not raany years ago such a procedure 
would have been looked upon as lunacy and the man who 
advocated it would have been r^arded as a fit subject for a 
lunatic asylum; to-day there is strong and cumulative, almost 
incontrovertible, evidence in its favor, and in the same light do 
we now regard the operations on the thoracic and on joint 
cavities, portions of the body which the old-time surgeons did 
not dare to enter. 

This doctrine is thoroughlv established now, and coming 
down directly to solid ground we may re-state it; that wher- 
ever pus is present and cannot otherwise be disposed o^ our 
duty is to explore and evacuate the contents if possible. Such 
a procedure in abdominal disease is at any rate applicable to 
acute peritonitis, a disease which is most generally fatal and in 
which some at least mi&;ht be saved by the operation who 
would otherwise die. It is rational and safe to say that open- 
ing the cavity will at least give the patient a chance for life 
which he had not before. Certainlv the operation is attended 
with great danger, and the responsibility of the surgeon is cor- 
respondingl}r increased and he must be certain as to diagnosis, 
full of faith in his own method, and have the courage to carry 
it out to completion. 

Now, thinking of this enlargement of the field of abdominal 
surgery, I want to refer to another case in the same number of 
the Medical News: 

"Professor Billroth, in the Allgemeine Weiner Medizinal Zei- 
twag of March 24, 1886, reports two cases in which oBsophagot- 
omy and gastrotomy were severally performed for the removal 
of a foreign body. In each case a set of artificial teeth were 
swallowed and necessitated operation. The history of the case, 
in which gastrotomy was performed, is as follows : 

' The patient — a girl nineteen years of age — while asleep 
swallowed her artificial teeth. All efibrts to extract them were 
fruitless and they finally passed into the stomach. Gastrotomy 
was performed and the ^hole hand was introduced into the 
stomach, but the foreign body was not discovered. Professor 
Billroth accordingly enlarged the incision in the abdominal 
wall and searched the entire abdominal cavity for the teeth, 
but again he failed to discover them. Search was now made 
in that portion of the stomach posterior to the gastrosplenic 
ligament and adjoining the vertebral column. This part of 
the stomach, owing to its position and attachjnents, cannot be 
withdrawn from the abdominal cavity from such an incision as 
had been made, and, therefore, had escaped examination. 
Professor Billroth reviewed the search with both hands, and the 
foreign body was discovered and extracted. The patient recov- 
ered with no bad symptoms.* " 

Now, '^ one swallow does not make a summer," neither does 



▲BDOMINAL 8UB0BRY. 211 

one such case establish a principle of practice, bat it undoubt- 
edly does furnish strong encouragement for the advancement of 
surgery in that direction, and everything in the recent history 
of surgery seems to point toward greater development of 
abdominal surgery and even more brilliant results in the Aiture 
than in the past 

In the next number of The Physician and Surgeon * there 
will appear in the correspondence a letter from Dr. Hurd who 
was K>rmerly a student here, now pursuing his studies in 
Europe, in which he refers to an operation by Professor Billroth, 
for obstruction of the duodenum in which a lower portion of 
the duodenum was stitched to the stomach walls and a new 
pyloric orifice established. 

No longer ago than yesterdav I was called to see a patient 
at Whitehall in this State. Unfortunately he was dead before 
my arrival, but the postmortem revealed facts which make the 
case one, on its individual merits, that is calculated to stimu- 
late our efforts in this department of abdominal surgery. The 
man was fifly-two years of age, and had died with symptoms 
of gastric obstruction. On examination I found the bowels and 
peritoneal cavitv healthy, and no departure from the normal 
condition anvwhere except at the pyloric orifice of the stom- 
ach. Here tne tissues were tied up in a hard puckered mass, 
and there was complete occlusion. 

A few facts in the history of this case are that, for a number 
of years, he had suflfered with what was called indigestion or 
dyspepsia. During these years he was under treatment with 
the varied success which is usual in such cases. About two 
years ago he was much worse, and not able to get relief at 
home, he went to the Battle Creek Sanitarium, where he grew 
very much better. The treatment here was principally dietary. 
On his return home he became worse again, and gradually the 
symptoms became more marked. Taking solid food would 
occasion great distress and severe vomiting. The pain was 
confined to the epigastrium, but the most careful examination 
failed to detect any tumor or evidence of malignant disease. 
Death finally occurred from a sudden attack of obstruction. 

This was a case in which, from an anatomical stand-point, 
a succebsfiil operation of the kind described by Dr. Hurd 
might have been performed, and a chance for life been offered 
an otherwise utterly hopeless case. 

In this class of cases modern surgery has done what a few 
years ago would have been considered impossible. No man 
can attempt to fix the limits for this department of surgery ; 
the revolutions and advancements in the future may far outstrip 
the three or four distinct and striking advances in this depart- 
ment of surgery, which it has been my lot to observe during 
my own proressional life. 

*Se6 page 196 of this number. 



212 ABDOMINAL SECTIOK — THERAPEUTICS. 

EDITORIAL PERISCOPE. 



ABDOMINAL SECTION IN HOSPITAL AMPHITHEATRE. 



There is reported in the Lancet of January 17, by Mr. J. 
Greig Smith, a series of twenty-five cases of abdominal section, 
performed by him in the Bristol Royal Infirmary. The char- 
acter of the operations is as follows: Ovarian cystoma, seven- 
teen; solid growth of ovaries, two; pyosalpinx, two; nsemosal- 
pin:c, one: exploratory, three. A prolaps^, adherent, and dis- 
eased ovary successfully removed through the vagina is not 
included. From the description, four of these cases were very 
unfavorable for operation; all, however, recovered save one, and 
here the cause of death was volvulus. 

These operations are performed in the general operating 
theatre, and no restriction whatever is put on students or visitors 
who may care to be present. For a week or ten days after 
operation the patient is kept isolated in a small ward ; there- 
after she is returned to the general ward. This infirmary build- 
ing is old, it stands in a low-lying poor neighborhood, and its 
wards furnish less than eight hundred cubic feet to each 
patient. 

THERAPEUTIC ADVANCEMENT. 



Since therapeutical investigators have advanced from the 
unsound empincal mode, to the rational physiological method, 
there has been a great change in the administration of reme- 
dies. Instead of prescribing with blind faith or a hap-hazard 
unbelief in the efficacy of drugs, the physician is now able 
from the data at his cx)mmand to enjoy the privilege of reason- 
ing to a conclusion, and selecting the remedy to be used. 

In a paper read by Dr. E. R. Squibb before the New York 
State Medical Association, he discusses the evidences of advance- 
ment by physicians of the present day in the use of remedies, 
as it has come under his observation in his peculiar relations 
to the profession in supplying to them the established articles 
of the pharmacopoeia. 

The thoughtful physician seems more and more to realize 
that his success as an individual, as well as that of the profes- 
sion, depends upon his real utility to the public. He thinks 
that physicians, and the public as well, are coming to under- 
stand more correctly than formerly the true value of the word 
cure. Physicians realize that their duty to the patient con- 
sists in directing and guiding him to a recovery, and not in 
professing to " cure " him of disease. It is thus that the real 
value and scope of remedial agents is becoming better under- 
stood, and to that degree true therapeutic progress is made. 



MEDICAL WOMEN IN INDIA. 218 

Dr. Sauibb says the profession are learning too, to recognize 
.the fact that it is not to oe trammelled in the administration of 
remedies by the arbitrary doses laid down in the text-books. 
Medicines are now given by the physician who is abreast with 
the times, to secure definite effects, and he appreciates the 
varying susceptibilities of different patients to tne action of 
particular agents and the varying susceptibility of the same 
patient at different times. 

Two other evidences of advancement have been noticed by 
Dr. Squibb: The greater care taken by physicians to secure 
pure medicines, and the closer study of the pharmacopoea and 
the more common use of the pharmacopceal tests; and the 
increasing tendency to simplicity of perscriptions and the 
abandonment of complicated formulse, with an increasing use of 
the more concentrated and reliable fluid extracts instead of the 
decoctions, infusions, vinegars and wines. 

MEDICAL WOMEN IN INDIA AND AFRICA. 



It is two years since the Association of Medical Women for 
India was organized, and its first annual report has just been 
recently published. This association owed its origin to the fact 
that a great proportion of the women inhabitants of India are 
forced by custom to lead a life of seclusion so complete, that 
they are not allowed to see a male practitioner, however urgent 
may be their need of medical aid. When any great peril does 
overcome the native repugnance to the male physician, the 
^* Doctor Sahib," upon being called in, is introduced by the 
husband or father into the sick-room, but a thick curtain inter- 
venes between him and the patient. A hand is put out round 
the curtain in order that the pulse may be felt, but the rest of 
the consultation is conducted through the male member of the 
family. In short the physician is expected to make a diagnosis 
of an unseen presence. Natives who in ordinary cases admit 
the male doctor, exclude him from the treatment of cases pecu- 
liar to woman. The success of woman doctors in America and 
the few in England suggested a way out of the difficulty, by 
bringing doctors of their own sex within reach of the women of 
that country. The credit of originating the scheme is due to 
an American resident in Bombay, Mr. Kettridge, who in con- 
junction with a Parsee gentleman started the idea, which was 
favorably received. Subscriptions were solicited and the expense 
of bringing out two women doctors was soon subscribed. Two 
wealthy native gentlemen (for the movement was mainly a 
native one), gave sufficient means to build a hospital and erect 
a dispensary. The first day the dispensary was opened, nine 
women presented themselves for treatment, and on the ninth 
day there were three hundred. Since then the average of one 
hundred patients a day has been maintained. There is work 



214 EMETICS. 

8a£5cient for twenty lady physicians. There is no hesitation 
on the part of the patients in going to the dispensary. 

Lady nurses are going from the English hospitals to do serv- 
ice in the army hospitals of the English army m Africa. A cor- 
respondent to the Sritiah Medical Journal, of March 28, speaks 
of their duty and of their character and appearance as follows: 

"There are four lady nurses on board the Oanaes; and we 
met four others lately bound for Suakim. They nave a hard 
duty, and will pass through trying times. Everyone speaks of 
the climate ana surroundings of Suakim during the hot months 
with terrors. But these ladies face the prospects cheerfully. 
They are well-tried and trained women; some have passed 
through the Afghanistan war, as well as the late Egyptian war; 
they have done duty at the military hospitals of Netley, Wool- 
ridi, and the Guard's hospital. Well-born, educated, and 
experienced * dressed in bright uniforms of gray dress, scarlet 
cape and white cap, they look trim, bright and womanly, and 
find everywhere a sympathetic and fViendly reception. Medical 
and combatant officers and men alike speak well of their inde- 
fatigable attention. Few medals have been better won than 
those which some of them wear and which all are likely to 
deserve." 



EMETICS. 



Under the subject, "Emetics: Their Present Neglect in the 
Treatment of Disease. Is it Reasonable? Is it Right?" Dr. 
C. J. Hare read a paper at the meeting of the Harveian Society 
of London, March 5. In certain cases emetics cured in a mar- 
vellously short time; and in others they alone appeared capa- 
ble of saving' life. Speaking generally, ipecacuanha was 
regarded by the author the most useful, in doses of twenty to 
twenty-five grains of the powder mixed with water, or of six or 
eight drachms of the wine. Now and then purgation resulted 
instead of emesis : but persistent diarrhoea was never set up. 
The chief value*or emetics consisted in their mechanical action 
upon the viscera. The stomach was not only emptied, but its 
innumerable follicles were cleared by pressure^ the lungs were 
compressed, and the mucus forced out of the air tubes, and the 
oescmhagus, larynx and fituces were swept clean. Allusion was 
made to cases of recurrent vomiting, commonly termed " bilious 
sick headaches," although more justly to be called "stomach* 
aches in the head." The persistent vomitings were endeavors 
of nature to expel the slimy mucus of the gjftstric follicles and 
the oiorbid ferments which it contained. The desired result 
was often at once effected by an emetic. Many anomalous 
ailments, accompanied by loss of appetite, nausea, the non- 
enjoyment of life, ill-temper, etc., were due to a similar cause, 
and similarly relieved. The removal of the ropy mucus was 



TREATMENT OF GOITRE. 215 

promoted by washing out the stomach by means of warm 
water, which excited additional vomiting. Emetics were 
sometimes of signal service in severe bronchitis and in cap- 
illary bronchitis ; the fear of " exhaustion " being jjroduced 
by emetics was almost confined to those who never administered 
one. Attacks of catarrhal croup might be cut short in children 
by half a teaspoonful of antimonial wine; and in membranous 
croup^ expulsion of the tough exudation was sometimes effected. 
Emetics were useful in the early stages of continued fever of 
scarlatina and of measles, and in some cases of whooping-cough. 
They were decidedly beneficial in the treatment of delirium 
tremens, and also in acute mania. By the same means the 
paroxysms of ague could be greatly modified, and either 
arrested or repdered more amenable to quinine. Drugs and 
diseases bore much the same mutual'relation as in former ages ; 
and as emetics were then found useful, so they would be now, 
if fashion did not prevent their employment. 



TREATMENT OF GOITRE BY INJECTIONS OF IODINE. 



In some recent lectures delivered by Mr. Victor Horsley on 
the thyroid body, he confines the operative treatment of ordi- 
nary goitre, whether cystic or adenomatous hypertrophy, to 
injection and excision, and states that there is only one danger 
from simple injection, but that one ^'extremely serious, namely, 
sudden death." 

For fear that this opinion from so eminent authority as Mr. 
Horsley might deter many from injecting goitres, which has 
been a most safe, successful and comparatively painless opera- 
tion, in his hands, Mr. W. J. Tivy communicates to the Britis h 
Medical Journal his experience of the use of iodine injection, in 
adenomatous goitres. In thirty-three cases he injected two 
hundred and ninety times, using from thirty to sixty minims 
of tincture of iodine for each injection, on an average each case* 
being injected about nine times. In most of the cases both 
lobes of the thyroid gland was goitrous. He, therefore, as a 
rule, performed an injection into, both lobes at each sitting. 
The only discomforts observed from the injections were now 
and then neuralgic pains in the teeth and behind the ears, 
lasting for a few minutes. In all cases the goitres were consid- 
erably reduced and the majority being perfectly cured in from 
three to six months. In no case was there failure to reduce 
the circumference of the neck around the goitre. 

In performing injection of iodine for goitre, puncture of the 
trachea or of any large vein must be carefully avoided, a par- 
ticularly safe spot for puncture being between the anterior 
iugular vein ana the sterno-mastoid muscle on either side. In 
large goitres, the injections ought to be done in various parts 
of the swelling where the goitrous hypertrophy is greatest, and 



216 DIETETIC THKATMENT OF DYSPEPSIA. 

not confined to one spot only; and the injections ought to be 
repeated every week for three or four weeks, doing both sides, 
if necessary, at each sitting, and, subsequently, every second 
or third week, for perhaps three or four more sittings, until a 
marked diminution is perceived in the circumference of the 
neck. Some diminution will generally be observable within 
ten days from the first injection. A screw hypodermic syringe 
is the best for the iodine injections, and the needles ought to 
•be very sharp and clean, as they become easily corroded by the 
•action of the iodine. Having drawn up from thirtv to sixty 
minims of tincture of iodine into the syringe, and be/ore screw- 
ing on the needle to the syringe, force a few drops of the iodine 
in the syringe through the needle, so as to effectually expel all 
:air from the nee Ue itself; and, having well oiled it with car- 
bolic acid (one in twenty), push the needle, to the depth of 
:about an inch, well into' the goitre, and, raising the syringe 
higher than the point of puncture so as to avoid injecting air, 
should any remain in tne syringe, slowly inject the iodine. 
When this has been done, rapidly withdraw the needle, pinch- 
ing up the skin around it to prevent any escape of the iodine. 
-Care ou'^ht to be taken to avoid tight collars while the process 
of injections is being carried out, and the neck must not be 
strained or pressed in any way. 

Mr. Tivy says: "Having practiced iodine injections in aden- 
omatous goitres for several years, adopting the foregoing pre- 
cautions, I consider the treatment most successful, rapid in its 
effects, and safe ; it is incomparably superior to the tedious and 
most unsatisfactory treatment by the application of iodine 
externally and iodide of potassium internally." 



DIETETIC TREA.TMENT OF DYSPEPSIA. 



In a paper read before the New York State Medical Society, 
upon the above subject. Dr. Austin Flint expressed dietary 
views which have excited only harsh and adverse criticism in 
s. number of our exchanges, but we are pleased to notice that 
foreign journals are not disposed to treat slightingly the views 
of a thinker that has reached the prominence as teacher and 
:author as that attained by Professor Flint. The British Medical 
Journal, of January 17, comments as follows: 

*'Dr. Austin Flint is arousing the prophets of common 
sense in relation to the management of the stomach and the 
•endeavor to overcome its difficulties. He is beginning to recog- 
nize that there is a physiological fallacy in the idea that what 
is called '^ weak digestion," or inability to take certain articles 
of food, is a malady which the sufferer ought either to take as 
a dispensation of Providence, or to meet by uncompromising 
:8urrender. This is how Dr. Austin Flint puts the matter: 
*** The mind plays an important part in the etiology of the 



DI£T£TIC TREATMENT OF DYBPEPSIA. 217 

affection. The old method of treatment was to strictly regulate 
the diet, drink very little or no fluids, and always leave the 
table hungry. Such treatment is entirely wrong. Dyspepsia 
may be developed by the attempt to regulate the diet by rules 
intended to prevent the affection. I always ask a patient, ^' Do 
you regulate your diet? " and he always answers in the affirma- 
tive. I have never known a dyspeptic to get well who attempted 
to roffulate his diet. Regulate by the appetite, by the palate, 
and by common sense. A patient may ask, " Am I not to be 

fuided by personal experience, and avoid such articles as I 
ave found to disagree with me?" I answer that personal 
experience is very deceptive. An article that would disagree 
to-day would i^ree to-morrow. Do not adopt the rules of eat- 
ing only twice or thrice a day. Be governed by the appetite. 
Those articles are most digestible which are most acceptable to 
the palate. Do not leave the table hungry. Take animal and 
vegetable products, and drink according to the want of instinct. 
The diet which, in healthy subjects, is conducive to health, is 
the best diet for dyspeptics. It is a fallacy to suppose that, in 
dyspepsia, the organs of digestion neea a prolonged rest. 
Patients should not be afraid to rely upon their digestive 
powers. Perfect cures have been obtained by following the 
mstincts of nature. Dyspepsia is most common in the better 
educated classes, because they endeavor to regulate their diet 
on scientific principles.' 

''There is much sound sense in this view. It is not new, 
but only the old-fashioned, sensible, manly one revived. Phy- 
sicians — some, at least, — who have not posed either as 'starving 
doctors,' or as anti-alcohol or anti-tobacco practitioners, have 
been striving to stem the cause of fanaticism in science, but 
vainly. Perhaps it was not worth while to struggle and toil 
against the stream. Those who have laid aside silently on the 
bank waiting until the tide turned, have had a less troubled 
time of it; and now it has turned, or is rapidly turning, doubt- 
less more from natural causes than the efforts made by oppon- 
ents of the ' fad ' of fashionable physicians. It will be amusing 
to see how the advanced fanatics contrive to change their 
policy. Already we hear it admitted that 'port is a good sus- 
taining wine.' Before long, perhaps, it will be perceived, that, 
since the days when good sound wine was recognized as a use- 
ful as well as permissible aid to digestion, and, in itself, a ser- 
viceable nutrient, the type of many maladies has been altered, 
and not for the better, while bad nervous affections and weak- 
nesses, neuralgia, throat maladies and a host of distressing and 
debilitating disorders, have been notably on the increase, while 
as regards the bete noir of the anti-constitutionalist — another 
development of the fad in physic — the gout, a suppressed or 
undeveloped form of the disorder has replaced tne genuine, 
old-fashioned ' enemy,' against which the weapons of art were 



218 DIETBTIC TREATMBKT OF DYSPEPSIA. 

infinitely more formidable than they are wont to prove against 
the bronchitic troubles, the kidney, liver, heart, brain and 
nerve-disturbances which have sprung into prominence as the 
type of the manifestation of Hhegout' has been reduced, or, 
snail we say, depressed — by the withdrawi>l of stimulants." 

The Journal regards the remarks of Professor Flint as 
appearing opportunely during the delivery and publication of 
Dr. Lander Brunton's Lettsomian *' Lectures on Disorders of 
Digestion — their Consejquences and Treatment," delivered 
beK>re the Medical Society of London. These also stand out 
conspicuously for containing ideas on the physiology of eating 
that are not generally accepted by profession or laity. An idea 
of the plan of thought of Dr. Brunton's lectures is easily 
obtainea from the following quotation: "The function of 
watching over the safety of the organism is not confined, how- 
ever, to the liver, but is shared by other organs. The liver acts 
as a porter to prevent injurious substances from passing from 
the intestine into the blood, but the tongue and palate are the 
porters which prevent obnoxious substances from being taken 
into the intestinal canal. As a general rule, though by no 
means without exception, substances pleasing to the palate are 
useful and not injurious to the organism. The nerves of taste, 
like those of sight and hearing, are nerves of special sense, and 
are capable of education. But while we usually regard the 
education of sight and hearing as a noble thing, we are too 
careless of the education of our taste, and look upon it, rather 
as something degrading. Yet the education of ihe nerves of 
taste should be looked upon in the same light as that of our 
other special senses; and cookery tias, I think, a perfect right 
to be ranked with music, painting, sculpture and architecture 
as one of the fine arts. The difference between cookery and 
music, or painting, is, that while the objects which give rise to 
sight and sound remain outside the body, we are obliged to 
swallow the substances which excite sensations in our nerves 
of taste. It is not quite sufficient to turn them over in the 
mouth and put them out again, because the full sensation is 
only obtained just in the act of swallowing. For this reason 
devotees to the art of cookery must either be content with a 
moderate enioyment of the pleasures of taste, or consent, like 
some of the Koraan emperors of old or Grerman students of the 
present day, to eject again the food and drink which they have 
already taken and enjoyed. Only rarely does one meet with a 
dinner which gives one the sense of high artistic perfection, 
although I remember having partaken of one such when 
enjoying the hospitality of a city company. Each course 
seeined to excite an appetite for the one which succeeded, and 
was accompanied by a wine so carefully selected that it gave 
zest to the food, while the food appeared to give additional 
flavor to the wine. This dinner was a revelation to me; it not 



CX>NDBN8ATI0NS. 219 

only showed me that cookery might rank as one of the fine 
arts, but taught me that it might be a powerful moral agent. I 
went to the dinner exhausted with over-work, irritable in 
temper, and believing that city companies were wasteful bodies, 
who squandered money that mi^nt be employed for useful 
purposes, and that they should pe abolished; I came away 
feehng strong and well, with an angelic temper, and firmly con* 
vincecl that cit^ companies had been Established for the express 

SHirpose of giving dinners, and ought on no account to be inter- 
ered with. Nor was the good thus affected of a transitory 
nature; the irritability of temper, which had disappeared in 
the course of dinner, did not return; and the morning after- 
wards, instead of awaking with depression and headache, I 
awoke strong, well, and ready for work, and remained so for a 
considerable length of time. Nor do I think that mine is a 
solitary case. A succession of heavy dinners is, no doubt, 
injurious; but when the organism is exhausted, a good dinner, 
with abundance of wine is sometimes of the greatest possible 
use. But there is one condition which must not be neglected, 
or otherwise the consequences will be anything but satisfactory; 
the dinner must be well cooked, and the wines must be thor- 
oughly good." 

CONDENSATIONS. 



Buboes have been rapidly cured by Martineau, according to 
the Lcmcet^ by touching them with Paquelin's cautery. 

Thb first legalized cremation in England was performed a 
few weeks ago at the crematory erected by the Cremation 
Society of England. The body was that of an aged lady, who 
was a member of the Cremation Society, and in her last testa- 
ment declared her desire for this method of burial. 



Therb is described in the Lancet the following method of 
preparing antiseptic silk : Boil Chinese twist for ten minutes 
in a two per cent, solution of chromic acid, and then soak for 
twelve hours in a one per cent, of the same. Dr. Freeman 
states that the sutiAres may be left in situ for three weeks with- 
out the occurrence of either suppuration or softening of the 
silk. 



The prize of forty thousand francs oflTered by the French 
Academy for some certain test of death to prevent people from 
being buried alive, was given to a physician who announced 
that on holding the hand of the supposed dead person to a 
strong light, if living a scarlet tinge is seen where the fingers 
touch, showing a continued circulation of the blood, no scarlet 
being seen if dead. 



220 CONDENSATIONS. 

The lesions from chlorate of potash poisoning were found 
by an autopsy held fifteen hours after death, by Dr. A. H. P. 
Lieuf, pathologist to the Saint Mary's Hospital, Brooklyn, to be 
extreme active hypersemic condition of both kidneys, and the 
malpighian bodies appeared throughout the whole cortical sub- 
stance as small black dots. The solitary follicles of the intes- 
tines were distinguished by this same dark color. The patches 
of Peyer had the same black hue. The bladder contained a 
small quantity of very bloody urine. The heart was fiaccid 
and contained fluid blood. * The other organs were compara- 
tively normal. 

Precocious Menstruation. — The account of a child thirty- , 
one months old who has menstruated since the age of four 
months is found in II Morgagni^ January 10. Dr. V. Dervier 
to whom opportunity was afforded to study the case, reported 
that she had at that age the facial expression of a girl ten or 
twelve years old. She ha<l breasts as large as small oranges, a 
well developed mons Veneris which was covered with hair, and 
the vulva was fairly developed. The child was intelligent but 
irritable, and the natural irritability was increased at the ap- 
proach of the menses. Tlie flow occurred regularly every four 
weeks, lasting about four days. 

It is claimed in the British Medical Journal by Dr. MuUan 
that quinine has produced contractions of the uterus under 
circumstances in which ergot has failed. He cites several 
instances from which the following inferences are drawn : (1) 
Quinine when given in doses of four grains, will occasion uterine 
contractions in the course of half an hour; (2) Cinchonism 
and other unpleasant after-effects are not produced; (3) The 
pains are intermittent in character and thus resemble the normal 
uterine contractions, — the condition of tetanic contraction does 
not occur; (4) Post-partum hiemorrhage is not likely to 
result after the use of quinine, because the uterus is not left in 
a state of exhaustion after delivery. 

Alexander's Operation. — As a fresh reminder, states the 
New York Medical Journal, that there is "nothing new under the 
sun," we read in a late number of the GentrablaU fiir Oyndkohgie 
that M. Alguie suggested the operation of shortening the round 
ligaments, as a cure for prolapsus uteri, long before that idea 
had occurred to Alexander. Subsequently Aran thought of 
applying the same method to the cure of retroversion. Freund 
also is credited with having studied out the operation and per- 
formed it on the cad.iver. The important point is that while 
the procedure had occurred to others as a possible one, Alexan- 
der was the first to put it into effectual practice. Whether or 
not the operation is called by his name, makes little difference. 



NEW PUBLICATIONS. 221 

A CjESAREAN Operation Performed by the Patient. — ^The 
New York Medical Joumai states that several of its European 
exchanges are giving currency to an account of a case of this 
sort that was lately presented before a Bohemian medical soci- 
ety. A peasant woman had born seven children, four of her 
labors having been terminated spontaneously, two with the 
forceps, and one by craniotomy. At her eighth confinement 
she had been in labor inefiectually for two days, with no attend- 
ant but a midwife, when she determined to perform the 
Csesarean section upon herself, as she had once heard a descrip- 
tion of that operation. Seizing a razor, she made an incision 
in the median line of the abdomen, which she carried down to 
the uterus. She then opened the uterine cavity with a bold 
cut and extracted a living child, together with the placenta. 
A few hours afterward the physician who reported the case 
found her exsanguinated, and with a dreadful wound of the 
abdomen, from which a coil of intestine protruded. Her sur- 
roundings were filthy in the extreme. The intestine having 
been cleansed and returned within the abdomen, the incision 
was closed, an antiseptic dressing was applied, and ihe patient 
made a perfect recovery, without a bad symptom. It is said 
there is every reason to believe the story. 



NEW PUBLICATIONS. 



HOLDEN'S ANATOMY: A MANUAL OF DISSECTION OF THE 
HUMAN BODY. By Luther Holden, late President of the Royal 
College of Surgeons of Enelanil ; Consulting Surgeon to Saint Bar- 
tholomew's and the Foundling Hospitals. Fifth edition. Edited 
by John Langton, Surgeon to, and Lecturer on Anatotny at, Saint 
!&rtholomew's Hospital ; Member of the Board of Examiners, 
Royal College of Surgeons of England. With over two hundred 
illustrations. 12mo: eii^ht hundred and eightv-six pages. Cloth 
and sheep. Philadelphia: P. Blakiston, Son <x Co., 1885. 

The fifth edition of this work, recently issued, comes im- 

S roved in those parts where it was possible to attain a greater 
egree of perfection. The entire work has been carefully 
revised. In some places the order of dissection has been 
changed, and upon tne anatomy of the nervous system and the 
organs of special sense, new illustrations have been added, and 
additional matter introduced. This valuable work has been a 
number of years a help and aid to student and practitioner, 
but probably not as familiar to the student of to-day as merited 
by the quality of the work. It fully meets the design of the 
author, being to fill the wide gap that exists between the two 
classes under which most of the works on anatomy can be 
placed. First, those that treat the science systematically, each 
system being described separately, and, therefore, impracticable 
for the dissecting room ; and second, those that by the amount 



NEW PUBLICATIONS. 

of detail and minate description, and the prominenoe which 
they receive, conceal the essentials and more important parts 
of the science. 

The several systems, regions and organs are treated of in ihe 
order in which they are met in dissection, and the various 
structures described as thus found. By this method the stu- 
dent is enabled to study those structures in the position, one to 
another, as he will have occasion to deal with them as surgeon 
and physician. Thus are the prominent features of anatomy 
traced in their natural relations, and the essential facts associ- 
ated to make them most practical. 



THE YEAR-BOOK OF TREATMENT FOR 1884. A Critical Review 
for Practitioaers of Medicine and Surgery. 12mo: three han- 
dred and sixteen pages. Philadelphia : hesL Brothers & Co., 1885. 

The object of the book is clearly stated in its preface, — " to 
present to the practitioner not only a complete account of all the 
more important advances made in the treatment of disease, but 
to furnish also a review of the same by competent authorities." 

The scope of the work includes all departments of practice, 
and all sucn recent pathological and clinical research as per- 
tains directly to treatment. Under each department appear 
abstracts of the contributions found in the literature or all 
countries upon the subject, including all the more important 
matters relating to treatment that have been published during 
the year ending. September 30, 1884. 

The scope of this small work can be given in no better 
way, than to print the subjects and their respective editors : 
" Diseases of the Heart and Circulation," by J. Michell Bruce, 
M. D., F. R. C. P. ; " Diseases of the Lungs and Organs of Res- 
piration," by R. Douglas Powell, M. D., P. R. C. P. ; ** Diseases 
of the Nervous System " by A. de Watteville. M. D., B. S. ; 
" Diseases of the Stomacn, Intestines, Liver, etc., by T. Lander 
Brunton, M. D., F. R. S. ; *' Diseases of the Kidneys, Diabetes, 
etc.," by Charles Henry Ralfc, M. D., Cantab., F. R. C. P. ; 
" Rheumatism and Gout," by Dyce Duckworth, M. D., F. R. C. 
P. ; " Ansemia and Allied Conditions," by Sidney Coupland, 
M. D., F. R. C. P. ; " The Acute Infectious Diseases," by F. A. 
Mohamed, M. B., Cantab., F. R. C P. ; " Medical Diseases of 
Children," by Arthur Earnest Sansom, M. D., London, F. R. C. 
P. ; " General Surgery,— Part I," by Thomas Bryant, F. R.C.S.; 
** General Surgery,— Part II," by Frederick Treves, F. R. C. S. ; 
'* OrthopoBdic Surgery," by J. Warrington Howard, F. R. C. S. ; 
** Surgical Diseases of Children," by Edmund Owen, F. R. C. S. ; 
" Diseases of the Genito-Urinary System," by Reginald Harri- 
son, F. R. C. S. : " Venereal Diseases," by Alfred Cooper, F. R. 
C. S. ; " Pelvic Surgery," by J. Knowsley Thornton, M. B., C. M. ; 
'' Diseases of Women," by John Williams, M. D., F. R. C. P. ; 
" Midwifery," by Francis H. Champneys, M. B., F. R. C. P. ; 



NEW PUBUCATION8. 223 

" DiaeaseB of the Eye," by Henry Power, M. B., P. R. C. S. ; 
'' DiseaseB of the Ear/' by Geoive P. Field, M. R. C. S. ; " Dig- 
eases of the Throat and Nose," By Felix L(Bmon, M. D., M. R. 
G. P., London : " Diseases of the okin," by Malcolm Morris, F. 
R. C. S., Edinoargh ; '^ Summary of the Therapeutics of the 
Year 1883-84," by Walter G. Smith, M. D. 

Under each of the above subjects are numerous abstracts of 
valuable articles, made hy the editor of the department, of 
which full references are given. 



HISTORY OF THE UNIVERSITY OF MICHIGAN. By Elizabeth 
M. Farrand, Ann Arbor: Register Publishing Company, 1885. 

The author has written this book, " for those who have been, 
or are, or shall be connected with the University of Michigan." 
In it has been collected from various documents and records 
among the archives of the University, its history, and an effort 
has been made to put on record something oi its traditional 
history, that exists only in memories which are now fast fad- 
ing." But little of the latter information can be obtained, and 
truly, "it is greatly to be regretted that the men who were 
students of the University in its early days have given us no 
reminiscences of their college lile, of its duties, its customs, its 
hardships and its pleasures so different from those of modem 
college life." To lessen ;this regret, and to preserve as much of 
its ear]y social life as possible, the author suggests, " that the 
classes which left the institution before the aays of college 
papers and of class histories should each have its historian, and 
that a determined effort should be made to collect reminis- 
cences of college life in Ann Arbor. 

From the introductory chapter, we learn that the first events 
which led to the founding ot the University date back to 1780 
and 1783, when the Northwest Territory was ceded to the 
United States government. Among the most early acts of Con- 
gress were legislations endowing visionary educational institu- 
tions. Through these acts when Michigan was organizied into 
a territory she was entitled to one township of land to establish 
a seminary of learning. It was not, however, until 1817 that 
the University had even an existence on paper. At that date 
Michigan contained less than seven thousand inhabitants in all 
its territory. During this year the governor and the judges 
adopted " one of the most curious acts for which Michigan has 
ever been responsible." The drafting of " An act to establish 
the Catholepistemiad or University of Michigan," is credited to 
the Honorable Augustus B. Woodward, one of the territorial 
judges. We connot refrain from making the following quota- 
tion from this enactment: "The Catholepistemiad or Univer- 
sity of Michigania, shall be composed of thirteen diadaxum or 
professorships; first, a didaxia or professorship of catholepiste- 
mia, the diaactor or professor of which shall be president of 



224 NEW PUBLICATIONS. 

the institution; second, a didaxia or professorship, of anthro- 
poglossica or literature, embracing all the epistemum or sciences 
relative to language, etc." 

It is sufficient to say that the Catholepistemiad did not 
advance to any greater perfection than the establishment of a 
primary and a classical school in Detroit. All the steps and 
changes of this beginning to its present grand result are faith- 
fully traced. The possession of the book will prove a great 
satisfaction to every one who has in any way become interested 
in the University. 

BOOKS AND PAMPHLETS RECEIVED. 



A RED-HEADED FAMILY. By Maurice Thompson. The Elzevir 
Library. New York : John B. Alden, Publisher. 

SANITARY COUNCIL OF THE MISSISSIPPI VALLEY. Seventh 
Annual Meeting, held in New Orleans, March 10-11, 1885. Pub- 
lished for the Information of Local Health Authorities. By order 
of the Board. John H. Ranch, Secretary. 

FORTY-SECOND ANNUAL REPORT OF THE MANAGERS OF 
THE STATE LUNATIC ASYLUM, AT UTICA. FOR THE YEAR 
1884. Transmitted to the Legislature January 13, 1885. Albany, 
New York : Reed, Parsons & Co., Legislative Printers, 1885. 

CATALEPSY IN A CHILD THREE YEARS OLD. Bv A. Jacobi, 
M. D., Clinical Professor of Diseases oL Children in the College of 
Physicians and Surgeons of New York. Reprinted from the 
American Journal of the Medical Sciences, April, 1885. Philadelphia : 
Lea Brothers & Co. 

LEGISLATIVE MANUAL AND OFFICIAL DIRECTORY OF THE 
STATE OF MICHIGAN FOR THE YEAR 1885. Prepared and 
published in accordance with the provisions of Act Number 263 of 
the Public Acts of 1875, by Henry A. Conant, Secretary of State. 
Lansinfl?: W. S. Greorge & Co., State Printers and Binders, 1885. 

ASIATIC CHOLERA IN NORTH AMERICA. National Conference 
of State Boards of Health held at Saint Louis, October 13 to 15, 1884. 
Subject: ''The Threatened Extension of Asiatic Cholera to North 
America, and the Action Necessary to Prevent or Limit a Cholera 
Epidemic." Illinois State Board of Health. Springfield, Illinois, 
1884. 

TYPHOID FEVER AND LOW WATER IN WELLS. By Henry B. 
Baker, M. D., Lansing, Michigan. Reprinted from the Annua) 
Report of the Michigan State Board of Health for the year 1884. 
Reprint number one hundred and eighty one. By Authority. 
Lan%<ing, Michigan : W. S. George & Co., State Printers and Bin- 
ders, 1885. 

MICRO-CHEMISTRY OF POISONS, INCLUDING THEIR PHYSI- 
OLOGICAL, PATHOLOGICAL, AND LEGAL RELATIONS. With 
an Appendez of the Detection and Microscopic Discrimination of 
Blood. Adapted to the use of the Medical Jurist, Physician, and 
General Chemist. By Theodore G. Wormley, M. D., Ph. D., LL. 
D., Professor of Chemistry and Toxicology in the Medical Depart- 
ment of the University of Pennsylvania. With ninety-six illus- 
trations upon steel. 8mo : seven hundred and eighty-one pages. 
In cloth, price, $7.50. Philadelphia: J. B. Lippincott & Co.^ 1885. 



EFFECTS OF EXCESSES ON THE MIND. 225 

MEDICAL DIGEST. 



THE EFFECrrS OF EXCESSES ON THE MIND. 



The mental effects on professional and business men, from 
unrestrained habits and other excesses, are faithfully pointed 
out by Dr. Rumbold in the following article published in th^ 
Saint Louis Medical and Surgical Journal: 

There are many professional and business men who suffer 
from a constant desire for change and excitement, from irrita- 
bility of temper, from inability to hold the mind continuously 
on a definite subject, from mental and physical weariness, from 
forgetfulness and a state of mind that tends to waver or jump 
from one trifling subject to another, whose condition is sokiy 
due to the effects of excesses. They almost universally lay the 
cause of their mental and physical ailments to close and long 
continued application of the mind. No doubt this is many times 
the case, but not as frequently so as some suppose. My obser- 
vations have lead me to believe that these symptoms are far 
more frequently the results of excesses and of colds, than of close 
mental application. Catarrhal inflammation of the nasal pas- 
sages is more frequently the cause of these symptoms of " brain 
exhaustion," as they are sometimes called, than is credited to it. 
As this inflammation is many times a painless complaint, the 
sufferers are entirely unconscious of its existence. If they do 
know it, or suspect it, they usuallv consider it as a trifling mat- 
ter, being long accustomed to slight attacks of cold in the head, 
which they have observed to pass away without producing seri- 
ous illness. Their expressions about their condition are usually : 
*' It's nothing but a cold. It will soon pass off," and such like. 
Besides neglecting their colds year out and year in, they disre- 
gard the laws of health by indulging in the use of tobacco and 
stimulants, thus increasing the congestion of the mucous mem- 
brane of the nasal passages and throat, which in turn has its 
effects on the brain, lungs, heart and stomach. Whether the 
nasal inflammation has the ultimate effect of producing hyper- 
semia of the brain, or whether this condition comes from, what 
is called, reflex action, I am not prepared to say, but I do know 
that brain disturbance very frequently follows such an inflam- 
mation. At the same time, these victims of excesses are taxing 
their weakened brain (which is now becoming sensative because 
of the hyperemia) to its utmost in attending to business. Not 
that their business requires more brain power than usual, but 
that their brain is not now equal to their usual business. 

Show me the man who has indulged in the use of tobacco 
and stimulants, even moderately, from his fifteenth year to his 
fiftieth year of age, and I will show vou a man who frequently 
complains of being exhausted while he is attending to his busi- 



22G EFFECTS OF EXCESSES ON THE MIND. 

xiess; he will also complain of the other mental ailments men- 
tioned and will require long vacations. If to these troubles he 
has added Other diseases, acquired through immoral practices — 
which are also partly the results on the mind of the use of 
tobacco and stimulants, the tobacco, through its depressing 
effects begetting a desire for stimulants, and stimulants, vene- 
real excesses — ^his cup will be full to overflowing. When such a 
man breaks down, he is more disabled mentally than physically. 

Show me the man who has not committed these or other 
excesses, and has been careful to avoid taking colds, and I will 
show you a man who does not require a vacation, except from 
^i p. M., each night to 6i a. m., next morning. He will be 
good for a full day's work, everv working da^, until he is 
seventy years old, and when he oreaks down, it will be from 
natural physical decav rather than from mental disability ; his 
mind will be clear and active. A marked contrast to the closing 
•days of the man of excesses. 

The man who does not commit these excesses, does not com- 
plain of being unable to get his business off his mind at bed- 
time. When he retires for the night, he sleeps soundly, and is 
-completely rested; after which his brain is ready for another 
hard day's work. He has no disease to maintain an unusual 
•quantity of blood in his brain, which is the sole cause of sleep- 
lessness. With him, as with other healthy persons, the usual 
normal proportion of blood leaves his brain when he goes to 
his bed for rest, so that sleep is possible. 

It is the man whose brain is in such a hypersemic condition 
that he cannot attend to business, that is unable to sleep soundly. 
In other words, he cannot sleep for the reason, as he sayS, that 
he has not sufficient command of his mind to withdraw it from 
his business, yet when he is in his office, he has not sufficient 
-control of his mind to hold it on his business, showing plainly 
that it is not because of attention to business, as said by almost 
evejy physician, but to other causes that prevent sleep; namely, 
a diseased condition of the brain, preventing the normal 
•decrease in quantity of blood in the brain that is a prerequisite 
to healthful sleep. 

"Oh," says some one to a forty-five years old merchant who 
"both smokes and chews tobacco inordinately and drinks whiskey 
•daily, "you have applied yourself so constantly and so long to 
-busineas that you have exhausted your brain; you are neuras- 
thenic, sir." 

This is not the whole truth, or rather it is an incomplete 
statement of the case, consequently the information given is 
erroneous, even worse than that^ it is dangerous. 

That his brain is exhausted is evident from his inability to 
Tise it as he formerly had done, but while this incapacity to 
attend to business demonstrates exhaustion, it does not prove 
that it is the cause of exhaustion. 



niB 



EFFECTS OF EXCESSES ON THE MIND. 227 

If I should see a farmer who lives in a malarial country, and 
whose whole system is broken down by daily attacks of inter- 
mittent fever, fail to follow his plow, I could as truthfully, or 
rather as correctly, say : " My dear fellow, you have plowed your 
farm for these fifteen years, it is too much for you, your mus- 
cular system is^exhausted, sir." That this farmer's muscular 
system is exhausted is evident from his inability to attend to 
his daily work, but does this weakness demonstrate that his 
work is the first cause of his disability? 

Are this farmer's muscles exhausted by the plowing or from 
the malarial fever? Is the merchant's brain exhausted by the 
attention to business or by other congesting agencies? It is 
exceedingly important to these two invalids to receive sl/vM as 
well as a correct answer to these questions. It is just as evident 
to me that the farmer's muscular weakness is not due to plowing 

86, as it is that the merchant's mental weakness is not due to 
is attention to business per se, and in the latter case, to the 
results from indulding his animal appetites to such an extent 
that his brain suffers secondarily. 

A large percentage of patients of this class have voluntarily 
stated to me that they had feared that the use of tobacco and 
stimulants had much to do with their inability to attend to 
business, but not being informed of their injurious effects and 
having acauired a confirmed taste for them, and seeing their 
medical aaviser, as well as other medical men of renown, 
addicted to the same excesses, they continued their habits and 
frequently endeavored to drown their troubles by still greater 
indulgences. 

With a few exceptions, these invalid business and profes- 
sional men would have desisted at once from these excesses, if 
they had been correctly informed of the cause of their infirmi- 
ties. This is the reason why I say that the physician, who 
informs his patient that attention to business is the sole cause 
of -his brain exhaustion, has given dangerous as well as erone- 
ous advice, because it is an incomplete statement of his case. 

If a business man observes that nis mind is clear and quick 
when his head is in a normal condition, and that it is dull, 
cloudy and slow when his head is affected by a cold, or in damp 
weather, or after he has partaken of a wine supper and smoked 
inordinately, he may rest assured that these symptoms of 
mental disability demonstrate plainly that it results solely 
from inflammation in his nasal passages and the cavities con- 
nected with them, and not from continued application of his 
mind to any subject. 

When the brain performs its functions, that is, carries on a 
train of thought, this act, in itself, induces a greater flow of 
blood to it than there would be, were it in a passive condition ; 
this is well known. Even the mental exertion involved in com- 
puting as simple a calculation as 2X2+2 — 2-^2=2 occasions 



228 EFFECTS OF EXCESSES ON THE MIND. 

some degree of hypersemia, but when the calculations are com- 
plex and involve numerous conditions, the degree of hypersemia 
must be far greater. 

It is evident that if a brain is made hypersemic by disease, 
as is done by chronic catarrhal inflammation, before commer- 
cial calculations and care are undertaken, relief from mental 
exertion would be as beneficial as desisting from following the 
plow would be beneficial to the farmer spoken of; but it is also 
quite as evident that relief from malarial influences in the one 
instance, and the congesting agencies in the case of the mer- 
chant, such as repetitions of colds, resulting from the use of 
tobacco and stimulents, -etc., that induce and maintain an 
abnormal flow of blood to the brain, are far more important 
matters. 

I will answer a few questions that I conceive might be asked 
of me, at this stage of the argument, namely: 

Is it not well known that there are professional and business 
men who do not commit the excesses spoken of here, and 
yet are troubled, mentally, as are those who do commit these 
excesses? 

Every individual that I have seen that has been afflicted 
mentally, as are those who have been addicted to the excesses 
mentioned here, has some brain trouble, it may be called 
hypersemia, which I prefer, or inflammation. The cause of this 
brain trouble may not always be the result of excesses nor 
always from inflammation of the nasal cavities, but in very 
many instances, to my certain knowledge, it is from inflamma- 
tion of this very part of the head! I ask, why is it not the most 
likely place to produce just this kind of a disease? 

These cavities and the sinuses connected with them are 
situated immediately under that portion of the brain that per- 
forms the mental functions. They are separated from it by a 
very thin plate of bone, and are very intimately connected with 
it by both blood-vessels and numerous nerves. As most of the 
blood-vessels in these chronic cases have for many years been 
congested to such an extent that they are from twenty to one 
hundred times their normal diameter, the nerves of this neigh- 
borhood, as well as other nerves connected with them, that 
have a great influence on the whole system, must be affected 
in the same proportion, and they in turn have marked effects 
on the function of the organs to which they are ultimately dis- 
tributed. 

That this is true is attested by the symptoms of every per- 
son who suffers from chronic catarrhal inflammation of the 
nasal passages, and prominent among these changes, is that of 
the disposition. 

It is a very frequent occurrence for such persons to exhibit 
great irritability, discontent and dissatisfaction, without appar- 
ent cause. 



EFFECTS OF EXCESSES ON THE MIND. 229 

• 

It is well known that a chronic complaint affecting any one 
of the extremities has the effect of producinoj an irritability of 
the disposition; how much more likely then will along con- 
tinued inflammation, situated immediately under the anterior 
portion of the brain produce a change in its function, the mind. 
Show me the man who does not have this inflammation and I 
will show you a man whose mind is normally clear. 

Is there any person who is menUiUy affected and has healthy 
nasal passages ? 

There may be. I do not say that there is no such a person, 
but I do say that I have not seen him. 

Does it follow that every man who has a normally clear 
mind is also perfectly healthy in his nasal cavities? 

Not any more than it follows that every man who passes ia 
a rapid gait before your door is perfectly healthy, some one of 
them may be attacked by sickness or even may die before 
night 

Does it follow that every man affected by nasal inflamma- 
tion must have some of the same mental disability that the 
professional and business men have who are addicted to 
excesses? 

Not any more than that everv man who has been shot 
through the body, the brain, or the heart will die, but most 
persons with nasal inflammation are so affected mentally, and 
most persons thus shot die therefrom. 

Does it follow that any man may be affected seriously, men- 
tally, by apparently a slight nasal inflammation? 

Yes, just as some persons are killed by trifling accidents. 

Are there not a large number of men who commit these 
excesses, apparently as healthy as are those who have not com- 
mitted the excesses? 

It is well to use the words *' apparently healthy" in this 
(question, for no such person can be healthy. It takes a longer 
time for these excesses to injure some than it does others; but 
every person, without exception, is injured by them when their 
use is continued long enough. 

Questions like these usually come from young men. I do 
not say young men as though it was a crime to be young, but 
because such inquiries are the expressions of these inexpe- 
rienced individuals. That men are apparently healthy while 
addicted to excesses, is to them a guarantee that they also may 
indulge in the same excesses with impunity. Their statement 
of these apparent facts, pointedly indicate that they want a 
good excuse to continue habits that at the present time are a 
pleasure only. 

Who hears of these men after they have been broken down 
from the result of excesses? May be not more than one in fifty 
of them are known to the public, yet this one, in all probability, 
has done more harm, in one month, to young men by his per- 



230 THE CAUSES OF STILL-BIRTH. 

nicious example and his ability to appear uninjured by his 
excesses, than he can correct by his daily regrets expressed 
during the last few years of his wretched life. It is the active, 
the apparently healthy, that are heard and seen, they are 
pointed to as proof of the harmlessness of the excesses, the 
mentally and physically wrecked ones are out of popular sight 
and hearing. 

THE CAUSES OF STILI/-BIRTH. 



At the stated March meeting of the New York County Med- 
ical Association {Medical Journal)^ Dr. John Shrady read a 
paper in which he referred to the difficulty of arriving at the 
lacts because of incomplete or false statistics. Among the chief 
of the devitalizing causes was syphilis, and, in illustration of 
the different ways in which the disease affected the foetus and 
the benefit to be derived from treatment, the details of several 
cases were given. From a consideration of the cases it appeared 
that the mother was more likely than the father to transmit 
syphilis to the progeny. There were certain other disturbances 
of the mother's health which might act as causes — such as 
malarial disease, ursemic poisoning, the eruptive fevers, inflam- 
mation of the vital organs, shock, etc. Of all these, uraemia 
seemed most dangerous to the foetus as well as to the mother. 
Among the local causes was disease of the placenta, especially 
so-called fatty degeneration — a term often used because it 
offered the readiest explanation of many phenomena, or was 
adopted to conceal ignorance. It was a question whether fatty 
degeneration of the placenta was not the product of foetal death. 
A certain amount of this change in the placenta, as well as in 
the uterus, might be seen tow&rd the latter weeks of pregnancy, 
and did not necessarily indicate disease. Tuberculosis had 
been alleged by some and denied by others to be a cause of 
still-birlh. Certain changes in the funis had been considered 
as a cause, also blows and falls, but many women who sustained 
blows and falls did not abort, and it might be that, in some 
cases in which such accidents had been asserted to have caused 
abortion, the real cause proceeded from an intention to produce 
miscarriage. He further mentioned prolapsus of the funis. 
The author then dwelt at greater length upon the reported 
postmortem appearances of foetuses born dead — ^such as changes 
in the heart, pleuritic adhesions, general fatty defeneration, 
suppuration of^the thymus gland, meconium in the air-passages 
and stomach, atelectasis, umbilical hernia containing the liver 
and most of the intestine, etc. The condition of the brain had 
often been interesting, serious effusion, apoplectic clots, etc., 
having been found. Dr. Shrady purposely avoided a discussion 
of abnormal presentations, malformation of the pelvis or small 
pelvic diameters, in the discussion of the etiology of still-births. 



PNEUMONECTOMY. 231 

PNEUMONECTOMY. 



Dr. Chas. E. Jennings writes to the British Medical Journal 
that from some operations performed on the cadaver, made in 
accordance with the suggestion recently made by Sir Spencer 
Wells, he has demonstrated the feasibility of removal of a part 
or the whole of a lung. The details are as follows : 

The root of the lung can readily be reached from behind^ 
through a triangular aperture in the chest-wall, made in front 
of the scapula. The subject having been placed in a suitable 
position, with the scapula drawn upwards and outwards, an 
mcision four and a half inches long was made parallel to, and 
two inches from, the median line of the body, commencing 
opposite to the third dorsal spine. The skin, fascia, rhom- 
boidei minor and major, and some fibres of the trapezius and 
latissimus dorsi, were divided. From the lower extremity of 
this incision another of similar length was made obliquely 
downwards and outwards along the upper margin of the eighth 
rib. The vessels divided by these incisions were of inconsider- 
able size. 

The flap, which consisted of skin, scapula, and soft parts,, 
was now thrown outwards and upwards, so that an interval on 
the chest- wall was cleared, which corresponded to the fifth,, 
sixth, and seventh ribs, with their intercostnl spaces. These 
ribs were divided transversely in the line of the first incision, 
and again rather obliquely along the line of reflection ot the 
flap. A triangular aperture was made in the thoracic parietes^ 
which aflbrdea ready access to the root of the lung. By such 
an operation abundance of space can be gained for the extirpa- 
tion of the lung; subsequently, eSicient drainage would be pro- 
vided for, and the aperture in the chest-wall would be well pro- 
tected by the scapula. 

Another operation was performed on the front of the chests 
An incision four inches in length was commenced parallel with 
the lower border of the first rib, and carried outwards towards 
the coracoid process: The skin, fascia, and pectoralis major 
were divided. A vertical incision was made from the third 
costo-chondral junction below to the inner extremity of the 
horizontal incision above. The upper border of the pectoralis 
minor having been depressed, the second rib was divided, first 
close to the outer extremity of the horizontal incision, and 
again through its chondral attachment. The intercostal muscles 
having been carefully divided in the lines of the cutaneous incis- 
ions, a flap, consisting of skin, fascia, pectoralis major, part of 
the secona rib, and intercostals, was thrown down, and the 
parietal layer of the pleura was divided. Free access was thus 

S;ained to the lung, and the aperture in the chest-wall was quite 
arge enough to permit the removal of a large part of the organ. 
In conclusion, so far as can be stated from these operations 



232 ALKALOIDS OF QUEBRACHO — BACTERIOLOGY. 

on the dead body, it does not appear that pneumonectomy, in 
actual practice, would be an extraordinarily difficult operation, 
and the entire lung could readily be removed by the first, or 
the upper portion of it, by the second, procedure. 

It is not often that pneumonectomy becomes the subject of 
consultation, though, in consideration of the large number of 
times a lung has been removed in the lower animals with 
impunity, the operation would, under certain circumstances, be 
indicated; and pneumonotomy, as Sir Spencer Wells said in his 
letter, might be performed more frequently than it is, with 
hopes of advantage, in cases of pulmonary cavities and gan- 
grenous lung. — Philaddphia Medicai Ihnea, 



ANTIPYRETIC ACTION OF THE ALKALOIDS OF QUEBRACHO. 



At the recent meeting of the French Association for the 
Advancement of Scie'-ce at Blois, a paper was presented by 
Drs. Huchard and Eloy on this subject (Le Progres Medical^ 
October 4, 1884). There are many alkaloids of this drug, no 
less than six having been already isolated. Numerous experi- 
ments having demonstrated the antipyretic action of these 
alkaloids, the authors were led to make trial of them in the 
human subject. In a certain number of patients with typhoid 
fever, to whom quinine had been given without effect, a nota- 
ble reduction of temperature was obt;iined by the hypodermic 
injection of the muriate of aspidospermine in doses of one and 
a half to three grains. This latter amount should never be 
exceeded. The authors noted especially the rapid reduction of 
temperature following the exhibition of these several alkaloids, 
and also remarked upon the changes occurring in the blood 
after their administration. The blood is changed in color in a 
way very similar to what occurs after poisoning by carbonic 
oxide. — Medical Record, 



RECENT PROGRESS IN BACTERIOLOGY. 



In reviewing the medical progress of the last year, we are 
struck with the large amount of work which has been done in 
the department of experimental pathology. It cannot be 
denied that much of this interest which has been awakened in 
a hitherto neglected subject has been due to Koch's discovery. 
Whatever may be its value from a practical point of view, the 
-enunciation of the parasitic theory of cholera has given an 
impetus to the study of micro-organisms. As a proof of this 
ivG refer not only to the spirited discussion which has been 
aroused regarding the identity of the cholera bacillus, but to 
the attempts which have been made to discover specific germs 
for many diseases not formerly regarded as parasitic in their 



LIQUORS — CHLOROHYDRATE OF KAIRINB. 233 

nature. The tubercle bacillus has been exhaustively studied 
by Baumerarten, Miiller, and Kanzler. Priedlander has appar- 
ently confirmed the existence of the pneumococcus ; Watson 
Cheyne has described a characteristic organism found in the 
blood of purpuric patients; Tayson and Goffky maintain that 
there is a specific germ for typhoid fever, and Gaudelin states 
that there is a micrococcus peculiar to dysentery; while Heub- 
ner has made careful studies of the micrococci of diphtlieria, 
and doubts their specific nature. Bacilli peculiar to tne follic- 
ular amygdalitis and glanders have been described. In cerebro- 
spinal meningitis, in osteo-myelitis, and in diseases of the jaw, 
such as caries, we learn that micro-organisms have been found. 
— New York Medical Journal. 



THE ABUSE OF ALCOHOLIC LIQUORS. 



A prolonged discussion upon this subject has been recently 
carried on in the German Society of Public Hygiene. The 
arguments advanced were not new, but they were supported by 
a number of interesting and important facts. Herr Mehlhausen, 
who closed the debate (which has been continued through sev- 
eral numbers of the Deutsche Medizinal Zeitung), referred to the 
extended observations which had been made in the Prussian 
army with reference to the utility of serving rations of schnapps 
to soldiers when in active service. The experiment had been 
thoroughly tried by the army surgeons, with the result of aban- 
doning spirits for tea and coffee. 

It was further stated that the majority of cases of frost-bite 
and sunstroke in campaigns were among those who were ad- 
dicted to strong drink. 

It was not the opinion of the society that such radical 
measures should be resorted to as had been taken in Maine, 
but it was suggested that much might be done by improving 
the quality of spirits and regulating their sale more strictly. 
As might be inferred, there was no plea for total abstinence. — 
New York Medical Journal, 



CHLOROHYDRATE OF KAIRINE. 



The properties of chlorohj^drate of kairine have been the 
subject of many experiments in Germany, where it has been 
frequently employeo. as an antipyretic in pneumonia, in typhoid 
fever and in relapsing fever. 

M. Brouardel and Loye have communicated to the Societe 
de Biologie the results of their studies of the physiological 
action of this medicament. They have demonstrated the proc- 
ess by which kairine lowers the temperature. It acts upon the 
blood, by profoundly idtering the composition of the hsemoglo- 



234 DRUNKENNESS AND DIPSOMANIA. 

bine, and thus diminishes the respiratory capacity and oi^anic 
combustion. 

In contact with kairine, the blood becomes immediately of 
chocolate color. In comparing its absorbing power of oxygen, 
before and after the introduction of kairine, considerable modi- 
fications will be observed; the blood does not take up any 
oxygen, and the spectroscope clearly indicates a destruction of 
the hsemoglobin: this is the chemical efiect upon the blood. 

Its physiological history, its influence upon respiration, the 
circulation and nutrition, is the work of M. Consience. 

In kairinized animals there is always trouble in the respira- 
tory ry thm ; these important modifications in the respiratory 
Ehenomena, relate to chemical actions. The production of car- 
onic acid diminishes progressively, and in proportion the tem- 
perature is lowered. But, as soon as the action of this remedy 
IS exhausted, the quantity of carbonic gas increases and the 
temperature rises. 

The variations in the composition of urine are still more 
remarkable, especially that of urea. Give a healthy dog daily 
one gramme of kairine, the quantity of urea will lesson from 
day to day, in the proportion of 9. 4. 3. 2. Discontinue the use 
of Kairine, the production of urea will increase, 1. 2. 3. 4. 

All these phenomena are evidently subordinate to the action 
of knirine upon the blood; this action explains the cyanosed 
lips, the blueness of the lungs, abundant salivation and paresis, 
etc. 

Its therapeutic value is problematical; there is hardly a dis- 
ease known, in which we should aim at the destruction of the 
haemoglobin, and restrain the field of h^ematosis. — Le Progres 
Medical, — Saint Louis Medical and Surgical Journal. 



DRUNKENNESS AND DIPSOMANIA. 



BY PROFESSOR KIRN. 



Dipsomania is a periodical melancholy, is characterized b^ 
sadness, headache, sleeplessness and incapacity to work; is 
overcome by an anxiety ; then only, the desire rises to get rid 
of all this by intoxication. The dipsomaniac drinks with relish 
and without satisfaction, yet he must drink. Sometimes, after 
long and much drinking, symptoms of acute or chronic alco- 
holism may set in. The differentiation of alcoholism and dip- 
somania depends upon the following points: 

(1) Dipsomania may be from heredity, or from previous 
nervosity, from peculiar psychical tendencies, or the advent of 
puberty and especially oi the climacterium, while drunkenness 
may be wholly independent of any of these causes. 

(2 ) Dipsomania runs in typical attacks, distinctly alternating 
with intervals of sobriety, while the excessive drinking of the 



MANAGEMENT OF NEW-BORN INFANTS. 235 

potator has no periodical limit. Abstinence, here, is only the 
result of exhaustion, of indisposition or want of food. 

(3) The attacks of dipsomania are induced by psychical 
depression with a corresponding parsesthesia, while the habitual 
drunkard resoits to the glass without such prodromal symp- 
toms. 

(4) Psychical alcoholic disturbances will set in at the acme 
of the attack, with the first, while in the latter they appear at 
the very outset. 

(5) The dipsomaniac is disgusted with his morbid impul- 
ses, battles bravely against the recurrence, while the enfeebled 
will of the drunkard evinces no energic opposition to the vice. 
Therapeutically, Kirn recommends 0.06, of opium three times 
at the dawn of the prodromal symptoms. 

(A hypodermic injection of five drops of four per cent solu- 
tion of muriate of cocaine has had a most happy and lasting 
effect in two cases of dipsomania of very long standing and of 
a very aggravated character. It was at first used daily, now 
only when prodromal symptoms appear. A perfect respite of 
six weeks has been attained, the attacks seem to be perfectly 
under control). — Saint Louis Medical and Surgical Journal, — 
Deutsche Medizinai Zeilwng. 

MAN AGEMENT' OF NEW-BORN INFANTS. 



The Medical World says : In the management of the new- 
bom infant we are gradually approaching nature's methods. 
In the maternity department of the Philadelphia Woman's 
Hospital the management of new-born babes has been as 
follows : 

As soon as the head is bom the' eyes are washed with an 
antiseptic solution. When the body is bom the child is left in 
the bed to await the expulsion of the placenta. No effort is 
made to remove the placenta under half or three-quarters of an 
hour; before this time it is generally expelled by nature. 
When the placenta is expelled it is placed m a pan, and the 
child is wrapped up and laid away with the placenta still 
attached. 

The child is now left and the attention is given to the 
mother. After the mother is cared for the child receives 
attention. By this time the pulsations in the cord have long 
since ceased. The cord is now cut and the blood " stripped °' 
out of the stump, but neither end is ligated. The stump is not 
dressed nor is any band put around the child's body. The 
child is neither washed nor dressed, only a diaper and a simple 
slip or gown is put on, and then it is warmly wrapped up and 
put in a little bed to itself. After twenty-four hours it is taken 
to the babies' bath-room (which is properly heated) and there 
it is washed and dressed. Dr. Lyng, the physician in charge. 



236 STILL-BIRTH — WHOOPING-COUGH. 

tells US that since this plan has been adopted the babies get 
along much better. We were in the wards of this department 
about an hour, and during this time there was not a single cry 
from the babies. They all seemed contented and happy, and 
were doing well. We are convinced that washing the child 
immediately after birth, or keeping it half-naked for a King 
time during the process of careful dressing is not good practice. 
— Obstetric Gazette, 



PREMATURE DETACHMENT OF THE PLACENTV A CAUSE OF 

STILL-BIRTH. 



For some years past, Dr. Getz says (Journal of the American 
Medical Association) he has entertained the view that the pre- 
mature detachment of the placenta in otherwise normal labors, 
was occasionally the direct cause of ^ still births," or the cause 
of the enfeebled condition of the child at birth, where only the 
most prompt and efficient ifleasures which can be brought into 
practice by the accoucheur, are the means of establishing respi- 
ration. He believes that a child born when the placenta remains 
attached to the womb until the child is expelled from the 
mother never requires any assistance to promote or establish 
respiration, and that where such assistance is necessary there 
has been either a partial or complete premature detachment of 
the placenta for a shorter or longer time prior to the expulsion 
of the child; and the circulation in the cord will be enfeebled 
or have entirely ceased in proportion to the length of time the 
partial or complete placenta detachment may have existed. 



WHOOPING-COUGH. 



In a clinical lecture {Medical Press and Circular) Dr. Robert 
J. Lee showed a case in an infant, seven weeks old, in which 
the disease seemed to have been carried by a third party. A 
woman whose child was suffering from the disease visited a 
family in which there was an infant four days old. Exactly 
ten davs from that time the first symptoms of the disease 
showed, themselves. No other exposure could be discovered. 
Attention is called to the fact that in very young infants the 
whoop is a very rare symptom, for the reason that such a child 
cannot *' vocalize a whoop." Diarrhea as a complication is 
emphasized. It is usually attributed to other causes than the 
whooping-cough. He has lost all faith in specifics for the dis- 
ease. For the laryngeal spasm he relies chiefly upon local 
measures, than which none is better than the inhalation of car- 
bolic acid in combination with oil of pine and compound tinc- 
ture of benzoin. The bromides and belladonna seem to dimin- 
ish the paroxysms for a time, but in severe cases no great benefit 
is derived from them. — Archives of PediaJbrics. 



CALOMEL — IODOFORM. 237 

THE RESOLVING ACTION OF CALOMEL IN VERY MINUTE 
D0SE8 IN THE TREATMENT OF PNEUMONIA. 



Chapois writes in the Bulletin Oen. de Therap. : The value of 
this means was suggested to the author by his experience with 
a case of pneumonia in a child twelve years of age, in which 
blisters, leeching, and other means of treatment have been una- 
vailing. The eighteenth day of the disease had been reached 
and still resolution had not begun, nor had the fever abated. 
It then occurred to him to try the administration of calomel in 
doses of two milligrams every hour. Twenty-four hours later 
the patient was re-visited and found to have a moist skin and 
a pulse of eighty per minute. The tongue was also moist and 
a sub-crepitant rdle redv/L could be heard over the affected lung. 
Recovery followed without interruption. 

The same treatment was subsequently used by the author 
in many cases of pneumonia, at all ages, with complete 
satisfaction. The phenomena which usually follow the use of 
this agent for twenty-four to forty-eight hours are as follows: 
Moisture of the skin, then of the tongue and the mouth ; next 
a diminution of body heat and of the sense of oppression. 
After fifteen or twenty doses have been taken, there may be a 
fluid evacuation of the bowels. The author does not claim 
that calomel is a specific for pneumonia, and in some cases 
other remedies will answer equally well. The advantage of 
the very small doses is that a different end is sought from that 
which is manifest when purgative doses of calomel are given, 
the effect of the latter being to prostrate the individual already 
greatly weakened. Given m such small doses, absorption is 
favored, the salivary glands, the liver, the intestinal and other 
mucous glands, also the glands of the skin, are stimulated, — in 
a word, ttiere is a general derivative action. — Archives of Pedir 
atrics 



THE PURITY OF IODOFORM. 



In addition to the usual or possible impurities contained in 
commercial iodoform, which are readily detected by a syste- 
matic analysis, or by the special tests given in some pharma- 
copoeias, there appear to be often certain others present, the 
nature of which is not quite understood, and which have 
probably not been exactly identified. Dr. Brouma, in Ley den, 
was led to believe that the discordant results obtained by vari- 
ous experimenters with iodoform were, at least partly, due to 
the presence of certain impurities; and, after having made a 
large number of experiments with pure iodoform which had 
been found to stand the (additional) test given below, he found 
that it did not produce the toxic symptoms reported by others 
— or, at least, but rarely. The test is the following: A certain 



238 TAPE-WORM — MISCELLANEOUS ITEMS. 

(quantity of iodoform is shaken for sorae time briskly with dis- 
tilled water, and the mixture then filtered. The filtrate is 
mixed with a little alcoholic solution of silver nitrate, and the 
mixture set aside for twenty-four hours. If the iodoform was 
impure, a black precipitate, consisting of reduced silver, will be 
formed; while, if the preparation was pure, there will only be 
a faint whitish-gray turbidity. All samples of iodoform which 
produce toxic symptoms, when tested m the above manner, 
reduced the silver solution. — American Druggist. 



PELLETIERINE IN TREATMENT OF TAPE-WORM. 



Dr. H. Wilfert reported seven cases of the use of pelletierine. 
He regards it as an efficient and safe remedy. He requires his 
patients to fast for one day and take a dose of castor oil or a 
saline cathartic at evening. In the morning the pelletierine is 
administered and followed in a half hour with a dose of the 
French compound tincture of jalap as recommended by Tanret, 
in lieu of which Dr. Wilfert has used a mixture of two drachms 
of fluid extract of jalap with three drachms each of fluid extract 
of senna and simple syrup in a doseof one-half to two drachms 
in sweetened water. 

If there be nausea and vomiting he gives ice and lemon- 
juice. The medicine acts quickly without griping. Pizziness 
was noted in every case coming on in five to thirty minutes 
after the medicine was taken, and continuing for one to four 
hours, and diminishing as the cathartic action be^ns. Pulse 
was slightly increased m some cases, but no elevation of tem- 
perature was observed. 

In every case the worm was expelled in about two hours.^^ 
Oincinnati Lancet and Clinic, December 27, 1884. 



MISCELLANEOUS ITEMS. 



Dr. R..L. Moore communicates the following formula for 
cystitis in old men with prostatic enlargement, to the Saint 
Louis Medical and Surgiccd Journal : 

R. Tinct. belladonna (German), 

Tinct. cantharides aa f Jj. 

M. Sig. 15 to 20 drops, at 2, 6, and 9 o'clock, p. m. 

The Most Powerful Antiseptics.— Studied by their power 
to prevent the development of micro-organisms in sterilized 
broth, the biniodide of mercury stands at the head of the list 
of antiseptics. It is three times as strong as the bicloride. A 
solution of a one-forty thousandth strength renders life impos- 
sible to any form of microbe, says M. Mirael, while of bichlo- 
ride the strength must be one-fourteen thousandth. — Medical 
Record. 



MISCELLANEOUS ITEMS. 239 

Beegh-Crbasote in Pulmonary Affections.— Dr. Lasinee 
recommends a combination of creasote, balsam of tolu, and 
Norway tar in the treatment of pulmonary aflTections. He gives 
the following formula: Pure beech creasote, one minim; puri- 
fied Norway tar, balsam of tolu, each one and five-tenths 
minims. Inclose in a capsule. In incipient phthisis, two such 
capsules should be Riven, morning and evening. In advanced 
cases the number of capsules may be increased to twelve daily. 



Iodoform in Organic Diseases of the Heart. — Professor 
Testa, of Messiana, has employed with success the treatment 
recommended by Moleschott fortherelief of functional disturb- 
ances in incurable disease of the heart. This consists in giving 
seven centigrams of iodoform in four pills daily, continuing it 
for some time, this lasting in one patient for nearly a month. 
It acts especially by diminishing the number of the beats of 
the heart and increasing arterial tension. — Oaaette dea HospUaie. 
— Medical Times and Oazette. 



Chloral Treatment of Diphtheria. — According to Dr. 
Galantin's work on the subject, the dosage should be six grains 
of chloral and six of chlorate of potash, to be given every hour 
to produce hypnotism; to children, two grains of each every 
hour; to infants, one-fourth grain chloral with two grains bro- 
mide ammonium and two drops chloroform. Dr. Galantin 
proposes chloral as a specific, basing his opinion on experience 
and the anaplastic property of the drug. He gives it even if 
the temperature be suonormal and the heart feeble. — Saint 
Louis Medical and Surgical Journal. 

Decoction of Valerian in the Treatment of Contusions. 
— Upon the suggestion of Dr. Grehant, Dr. Aragon has made 
a trial to determine the value of a decoction of valerian root, 
as a dressing for wounds, and especially for contused wounds. 
The decoction used was of the strength of thirty grains of valer- 
ian root to one litre of water. The cure was no more rapid 
than that obtained with other dressin^H, but from the first 
application the pain was completely abolished. This is a point 
of considerable importance if it should prove to be sustained 
in further trials. — Lyon Medical. 

Professor Bartholow has seen remarkable good results 
from full doses of salicylic acid in neuralgia, lumbago, and 
sciatica. Bromide of lithium in doses of ten to twenty grains, 
three or four times a day is often another valuable remedy, 
especially where there is nervous restlessness and wakefulness. 
Locally, in obstinate cases of sciatica, the best results can be 
obtained from the deep injections of chloroform. Where this 



240 MISCELLANEOUS ITEMS. 

is not desirable, dry cups may be resorted to with distinct 
advantage or a liniment of the oil of wintergreen may be 
applied. — New England Medical Monthly, 

A French Treatment for Ulcers op the Leg. — Dr. Vidal 
recommends {V Union MedicaU) the following treatment, which 
he has found very efficacious, especially for indolent ulcers 
with pale base and ichorous secretions: First, wash the ulcer 
with an infusion of oak leaves, then cover with a layer of sub- 
carbonate of iron. A poultice of potato starch is then applied 
and retained by a roller bandage. Healing is complete in from 
ten to forty days. The subcarbonate of iron has an action upon 
the ulcer at the same time astringent and tonic. It gives new 
life and activity to the tissues. The galvanometer shows a 
considerable giving oflf of electricity, which explains, according 
to the author, the beneficial action of the iron. — Medical Record, 

Successful Treatment of Thread-Worms. — Dr. Millard, of 
New York, in a communication to the Medical Record^ calls 
attention to the fact that the habitat of the oxyuris, or thread- 
worm, is not the rectum, but, as pointed out by Cobbold, in the 
colon, and especially the csecum. In the treatment of a case of 
a lady twenty-three years of age, after injections and local treat- 
ment had entirely failed, he obtained a rapid cure by adminis- 
tering forty-five drops of Parke, Davis & Co.'s fluid extract of 
pomegranate root before each meal; santonine one half to two 
grains between meals and at bedtime, with sulphate-of-soda- 
waters (PuUna, Marienbad) before breakfast, to cleatise the 
mucus from the intestinal tract.— P/ii/acfeip/im Medical Times. 

Gonorrhcea and Chordee. — Troublesome gonorrhoeal cases 
do not fail to occur except in the experience of those who are 
in the possession of unfailing remedies. A retired army sur- 
geon, without apparently expecting such good results, ordered 
lor an officer, some fifteen years ago, who was just about to 
present himself for duty, but who was suffering from gonorrhoea, 
associated with intense chordee at night, the following two 
preparations: Aqufe, seven ounces; mucilago-acacise, one 
ounce; extract belladonnce, twenty grains ; and zinci sulphate, 
twenty grains. A teaspoonful injected frequently. The other 
is an external application consisting of unguenti spermaceti, 
four drachms; unguenti hydrargyrum, four drachms; extract 
belladonnsB, ten grains; extract opii, ten grains. To be smeared 
freely along the perineum and around the crura penis at nignt. 
"Complete cure" occurred within a week. The following injec- 
tion for gonorrhoea is also recommended. It is claimed to be 
superior to any other single injection: Pulverized iodoform, 
twenty; acidi carbolici, ten ; glycerini, eighty; aquse distillate, 
two hundred. — New York Medical Journal. 



THE 



PHYSICIM AKD SURGEOS 

A MONTHLY MAGAZINE, 
DEVOTED TO MEDICAL AND SURGICAL SCIENCE. 



Volume VII. JUNE, 1885. Number VI. 



ORIGINAL ARTICLES. 



A CASE OF UTERINE "HYDATIDS" WITH ALBUMINURIA. 



BY H. C. PADDOCK, M. D., Battle C&eik, Michigan. 

Two years ago I was called to see Mrs. D., aged thirty-five 
years, who hadoeen in poor health for eighteen months. She 
was the mother of four cnildren — the youngest three years old. 
I found her unable to sit up, and there was general anasarca. 
The abdomen was greatly distended, and contained a large 
amount of fluid. Her features were swollen, and the eyes 
sunken. She was aneemic and had no appetite. The bowels 
were constipated, but at intervals there was a diarrhoea. I also 
found her menses irregular ; for the past three months she had 
most of the time a muddy colored discharge, which continued 
through the month, stopping at only short intervals of one or 
two days. 

On making a vaginal examination I found a shortening of 
the neck, with the body of the uterus greatly enlarged, indi- 
cating a pregnant condition. On analysis of the urine, both 
fdbumen and granular casts were found. I informed the patient 
she was pregnant and had Bright's disease of the kidneys. 
I did not give her my prognosis, but informed her friends 
of the grave nature of the case. ^ 

The following prescriptions were given to carry off the 
dropsical effusion : 

NUMBER OKE. 

B. Elaterium 15 grammes. 

Extractum conii 65 grammes. 

Misce et ft. masH in pil. number twenty div. Sig. One pill every 
two hours until the bowels move. 



242 UTERINE HYDATIDS WITH ALBUMINURIA. 

It had the desired effect. She discharged a large quantity 
of the water, without distress, which greatly relieved the patient. 
I directed her to take a strictly milk diet (one to one and 
one-half litresj in twenty-four hours, and gave prescription 
number two. 

NUMBER TWO. 

B. Potassii iodidum 10 grammes. 

Syrupus pruni Virginianee 192 grammes. 

Misce. Sig. One spoonful (four grammes) before each meal. 
Also prescription number three. 

NUMBER THREE. 

H. Tinctura ferri chloridi 32 grammes. 

Syrupus limonis 160 grammes. 

Misce. Sie. One spoonful (four grammes) after each meal, well 
diluted througn a glass tube. 

To keep the bowels regular, an important element in the 
successful treatment of such troubles, prescription number four, 
called Palmer's laxatives, was given. This does the work 
nicely, without the debilitating effects or irritation usually 
<;aused by cathartics in general. 

NUMBER FOUR. 

B. Aloes (purified) 4. grammes. 

Ext. hyoscyamas 4. grammes. 

Ale. ext. nux vomica 80 grsmmes. 

Pulvis ipecacuanha 40 grammes. 

Misce et ft. mass in pil. number thirty div. Sig. A whole or part 
'of a pill each night, as the case may require. 

Under this treatment the anasarca gradually diminished, and 
she gained, in a few weeks, considerable strength ; when all at 
once she was taken with abdominal pains and flowing, the con- 
tractions of the uterus being severe. I was immediately sum- 
moned, and found her in labor. In a few hours she was deliv- 
ered 01 a " hydatid " weighing seven pounds, with a foetal liver 
attatched measuring four inches in length by about two inches 
in width. This was all there was of anything resembling 
foetal structure. She now convalesced slowly, and so far im- 
proved in eight weeks that she was able to ride out. The 
uterus returned to its normal condition, and her general im- 
provement continued. At the end of six months she weighed 
one hundred and thirty-five pounds, and was able to look after 
her household duties ; indeed, she was quite well. 

Shortly afterward the patient again became pregnant, and 
carried it to full time, and I delivered her of a ten pound child. 
:She at this time had no return of the albuminuria, which 
had previously disappeared, and I had the satisfaction of 
seeing a happy termination of an exceedingly bad and com- 
plicated case. 



OSSIFIC UNION — HYDROCELE OF THE NECK. 243 

OSSIFIC UNION IN THE AGED. 



BY E. G. FISH, M. D., M06INKB, WnoONSiN. 



On December 4, 1884, Mrs. Mary Roe, aged ninety-three 
years, residing at Mosinee, Wisconsin, was thrown from a 
sleigh box, striking her left shoulder on the frozen ground, pro- 
ducing a dislocation with fracture of the surgical neck of the 
humerus. 

When reaching the patient, an hour after the accident, she 
was suffering great pain and shock. With the patient anaes- 
thetized the dislocation and fracture were reduced. A straight 
splint, roller bandage and elbow support constituted the sur- 
gical apparatus used. In a few hours extensive ecchymosis, 
involving the greater part of the left side of chest, shoulder, 
axilla, arm and forearm, occurred, giving rise to fears of gan- 
grene. Stimulating and antiseptic lotions were diligently 
applied. A pyrexi^ condition came on, which lasted several 
days. Owing to the extreme old age and accompanying 
debility a liberal supporting tonic treatment was persevered in 
with the most grati^ing results. 

Four months after the accident the aged patient was seen, 
and it can be said she fully recovered the former usefulness of 
the member and was comparatively healthy. 



CASE OF HYDROCELE OF THE NECK. 



BY ANNA M. OCEBEL, ANN Asbob, Michigan. 



There was admitted February 18, 1885, to the Michigan 
State Hospital for treatment in the surgical clinique, a small 
patient with a somewhat rare affection which, witn the treat- 
ment and its peculiar effects, deserves recording. 

Emma P., aged, four years. Child of fair complexion, well 
developed and well nourished. When quite young she was 
easily thrown into a feverish excitement, and was considered 
delicate and highly nervous. She often complained of head- 
ache and other nervous symptoms. During the latter part of 
March, 1884, she passed through a mild attack of scarlet fever, 
from which she made a good recovery, but did not become strong 
and perfectly healthy, remaining delicate as before the attack. 
Sometime in May, 1884, the parents of the child noticed a 
swelling on the right side of the neck, under the ear. It came 
on suddenly, and increased rapidly for a short period after it 
was first noticed. At times it would become smaller, and at 
other times increase in size. The growth, however, was con- 
stantly getting larger. 

Wnen the child appeared before the clinic a large tumor, 
filling up the depression below the angle of the jaw, and pro- 



244 HYDROCELE OF THE NECK. 

jecting as a large mass between the sterno-cleido-mastoid muscle 
and the larynx, was noticeable. It was soft and boggy to the 
touch. To the eye the tumor looked as if it were a well defined 
growth, but upon manipulation it would recede under the 
muscle, and not the slightest trace of an edge or limit could be 
detected on the most careful examination. Upon any attempt 
to grasp the growth, it would glide from between the fingers 
and almost completely disappear. The child being timid began 
to cry, when the tumor disappeared in front of the muscle, to 
a great degree, and formed a large swelling under the occipital 
bone behind the muscle, so that a portion appeared on each 
side. It then had the appearance of a large growth constricted 
by the muscle. The muscle, however, was not tense, and none 
of the movements of the head or neck were in the least re- 
stricted. As soon as the child would stop crying, it would resume 
its former shape and position 

After examining the tumor and pointing out the above 
characteristics. Professor Maclean remarked, that the tumor in 
appearance was very deceptive. At first sight it appeared like 
a large solid growth, but as soon as the hand was laid upon it, 
the soft yielding nature immediately excluded the possibility 
of it being a solid structure, which would help in making a 
diagnosis by eliminating any form of solid growth, as fatty 
tumor, enlarged gland, fibroid, adenoid, or any malignant forma- 
tion. By placing both hands on the growth, fluctuation could 
be detected. It evidently was a large, irregular, delicate cyst. It 
was very difficult to determine its limits, being indefinite and 
peculiar. It is a form of cyst that is quite rare in this position, 
and comes under the head of what has been described as 
hydrocele of tlie neck, and will be found to contain a clear 
yellowish fluid. In a child of this age, before a positive diag- 
nosis can be made, the patient should be put under an ansas- 
thetic and an exploratory examination cautiously and care- 
fully made. 

The child was immediately placed under the influtoce of 
chloroform and a trochar and canula introduced. Several 
ounces of clear, yet somewhat glairy straw-colored fluid were 
drawn ofl". After the fluid had been evacuated as completely 
as possible, two drachms of strong tincture of iodine were 
injected into the cyst through the canula, before it had been 
removed. 

Within twenty-four hours the neck was as full as before the 
fluid was drawn away, and during the second day it was much 
larger, and the skin was hot and red. On palpation no fluctu- 
ation could be detected. The redness and swelling now rap- 
idly disappeared, and on the third day no trace of the former 
difficulty could be seen, but a small hard swelling could be 
felt, the result of some inflammatory thickening. 

The injection of the iodine produced no visible eflects save 



} 



HBALTH IN MICHIGAN. 



246 



the local irritation. At the suggestion of Dr. Hendricks its 
constitutional effects, which were well marked, were carefully 
observed. That thes^ might be accurately noted the tempera- 
ture and pulse were taken frequently for six hours, and then 
three times each for two days. The following is the record: 



DATE. 


TIME. 


PUME. 


TEMPERATURE. 


February 18 


3:30 p. M. 
4.40 p. M. 
6:00 p. M. 
7:00 p. M. 
8:00 p. M. 
9:30 p. M. 
8:45 A. M. 
1:25 p. M. 
7:30 p. M. 
9:00 A. M. 
1:30 p. M. 
8:.30 p M. 


116 
112 
100 
108 
104 
88 
117 
115 
104 
105 
112 
120 


988 


February 19 


98.2 

97.4 

96.6 

96. 

97.2 

98.2 


February 20 


98.5 
97.2 
98.7 




998 
99.4 



From this record it is seen that tlie temperature steadily 
and rapidly fell below the normal until it reached the low 
record of 96°, which it attained in six hours from the time the 
iodine was injected. When the thermometer made its lowest 
record, there was not observed the slightest evidence of such 
great depression or of collapse. It is to be noticed also, that 
while the pulse rate was lessened it was not in proportion nor 
in harmony with the reduction of temperature. The constitu- 
tional effects of the iodine seemed to be purely antipyretic. 



• GENERAL CORRESPONDENCE. 



HEALTH IN MiqHlGAN DURING APRIL. 

Reports to the State Board of Health, Lansing, by regular 
observers in different parts of the state, show the diseases which 
caused most sickness in Michigan during the month of April 
(four weeks ending May 2), 1885, arranged in order of greatest 
prevalence, as follows: 

Rheumatism, neuralgia, bronchitis, consumption of lungs, 
intermittent fever, tonsilitis, influenza, pneumonia, remittent 
fever, erysipelas, diarrhoea, inflammation of kidney, inflamma- 
tion of bowels, whooping-cough, scarlet fever, diphtheria, inflam- 
mation of brain, measles, dysentery, cerebro-spinal meningitis, 
typho-malarial fever, cholera morbus, puerperal fever, membra- 
nous croup, typhoid fever (enteric), cholera infantum, small- pox. 

For the month of April, 1885, compared with the preceding 
month, the reports indicate that intermittent fever increased, 



246 TREATMENT OF ASIATIC CHOLERA. 

and that pneumonia, influenza and tonailitis decreased in prev- 
alence. 

Compared with the average for the month of April in the 
seven years, 1879 to 1885, measles, intermittent fever, pneu- 
monia, diphtheria, and scarlet fever, were less prevalent in 
April, 1885. 

For the month of April, 1885, compared with the average 
of corresponding months for the seven years, 1879 to 1885, the 
temperature was slightly lower, the relative humidity was 
more, the absolute humidity was slightly more, and the day 
and the night ozone were considerably less. 

Including reports by regular observers and others, diph- 
theria was reported in Michigan in the month of April, 1885, 
at thirty places, namely, — Adrian, Alamo, Armada, Brighton, 
Detroit, Evangeline, East Saginaw, Fowlerville, Gaines town- 
ship, Grand Rapids, Hastings, Hope township, Jackson, Kala- 
mazoo, Lansing, Linden, Manistee, Mead's Mills, Mears, Mil- 
ford, Mundy township, Oshtemo, Paw Paw, Pontiac, Pentwater, 
Plymouth, Sand Beach, Weare, Wyandotte, Ypsilanti. Scarlet 
fever twenty-seven places, — Brown City, Comstock township, 
Detroit, East Saginaw, Grand Rapids, Ithaca, Jackson, Kala- 




Southfield township, South Haven, Wyandotte. Measles at 
seventeen places, — Bath, Detroit, East Saginaw, Grand Rapids, 
Ithaca, Kalamazoo, Manton, Marshall, Moorestown, Niles, 
Northville, Paw Paw, Pierson, Port Huron, Saint Charles, Stan- 
ton and Wyandotte; and small-pox at Bellevue, Alba and South 
Haven. Henry B. Baker, Secretary. 

Lamsimo. May 7, 1885. ___^_^__^______ 

ORIGINAL TRANSLATIONS. 



FRENCH LITER A TURK. 
Tbanslatkd by E J. WHITEHEAD, A. B., Ann Abbob, Michigan. 



treatment of ASIATIC CHOLERA. 



The treatment of Asiatic cholera comprises two parts: The 
prophylactic and the curative. 

The prophylaxifl is subdivided into that of the poj^ulation 
and of the individuals. 

Prophylaxis of Population. — To preserve a community 
the epidemic must be circumscribed in its primitive home 
which can be affected by maritime and land quarantines, and 
then to extinguish the scourge by local hycenic measures. 
These measures consist in maintaining scrupulous cleanliness^ 



TREATMENT OF ASIATIC CHOLERA. 247 

in transporting the cadavers to special places, and in their 
speedy inhumation, and, still better, in cremation, in cleansing 
and disinfecting the habitations by fumigations with sulphur, 
chloric or hypoazotic acid, in destroying the habiliments and 
beddings, and, above all, the dejections of the choleraic, either 
by disinfectants or still better by fire. 

Among the disinfectants, the sulphate of iron or sulphate of 
zinc are advisable in the following formula : 

R. Phenic acid 10 grammes. 

Salphate of iron 500 grammes. 

Water 10 litres 

The prophylaxis of individuals who cannot leave the chol- 
eraic homes, consists simply in not deviating from the general 
laws of hygiene. It is, above all, necessary to preserve the 
ordinary habits of life. It is just as perilous for persons 
habituated to the use of alcoholic drinks to abstain completely, 
as for a sober individual to enter into excesses. A gradual 
return to a healthy hygiene, if one was in the habit of swerving 
firom it. 

The greatest cleanliness in houses in the preparations of 
food, or in the choice of beverages. If the source of water is 
unl^nown it is best to heat and filter it. Preventive medicines 
should be used with the greatest caution, lest they irritate the 
stomach, or cause an undue excitement of the digestive tube. 
We would not even advise the use of copper, though strongly 
recommended by the distinguished Dr. Burg, the metallother- 
apeutist. 

We have great faith in the use of gaseous or atomized dis- 
infectants. An exposure of a few minutes to the gases of 
hypoazotic acid, to atomized phenic acid, or boric acid, would 
bean excellent practice. It would at least prevent one from 
becoming the vehicle for transporting the disease. 

Curative Treatment. — We must distinguish the treatment 
of the prodroma and of confirmed cholera: 

TreatToent of prodroma. — These are digestive or nervous trou- 
bles. If troubled digestion, if painful and slow, resort to imme- 
diate and absolute repose, and place in the best possible 
hygienic condition, and give four to six or eight drops of some 
anodyne. 

If there is colic and diarrhoea, repose in bed, cataplasm 
upon the abdomen, warm bath, astringent drinks of sulphuric 
lemonade. If the symptoms are intense, resort to bismuth or 
even opium: Powdered opium, twenty-five milligrammes. Sub- 
nitrate of bismuth, one gramme': to be given at once and 
repeated every two hours. Sleep must not be interrupted. 
Against the nervous symptoms opium is also the best. Anti- 
spasmodics and warm bath may be added. 

Treatment of conimned cholera, — Here again the less intense 
must be distinguished from the grave symptoms. 



248 BULLET WOUND OF THE STOMACH. 

The frequent evacuations and algidity must be at once 
combatted. Begin by giving fifteen to twenty drops of Syden- 
ham's laudanum in a little water, even forty drops may be 
given in twenty-four hours. At the same time enemas of a 
decoction of rhatany and laudanum, small quantities of ice, of 
champaign frappe. 

The uncontrolable vomiting can sometimes be arrested by 
sinapisms over the stomach, or instantaneous blistering of the 
Abdomen with spirits of ammonia or chloroform. A piece of 
punk saturated in chloroform placed on the stomach will 
cause vesication in five minutes. If the symptoms improve, 
give a little warm tea of mint, or warm wine, also the following 
prescription : 

B. Ether 1 gramme. 

Acetate of ammonia 4-S grammes. 

Tr. of annis seed 4 grammes. 

Julep 125 grammes. 

While these remedies are being prepared, aromatic frictions 
mav be employed, — sinapism, massage, urtication, application 
of not water, a flannel dipped in turpentine placecl on the 
atomach and a hot smoothing iron run over it. 

In very grave cases, when absorption by the digestive tube 
is entirely gone, hypodermatic injections of ether or of mor- 
phine may be tried, atomizing with alcohol. 

If reaction has taken place, an expectant treatment is 
advisable. 

The resume of the above is, briefly, when called to a case 
of Asiatic cholera: 

(1) Produce heat by all possible means, — externally by 
friction, hot application, — internally by warm punch, cham- 
paign. 

(2) When there is vomiting and persistent purging, give 
injection of rhatany, laudanum, ice, also subcutaneous injection 
of ether and morphine. 

(3) When it is evident that no absorption is going on, rely 
upon subcutaneous injection and atomization of alcohol. — 
Repertoire de Therapeutic Medicate. 



BULLET WOUND OF THE STOMACH. 



Dr. Deschamps' object in reporting this case is to show that 
a bullet wound of the stomach is not necessarily fatal, and to 
indicate that an oblique passage of the bullet through the wall 
of the stomach is a condition upon which a favorable result of 
auch an injury might depend. The case which suggested this 
view is as follows : 

A man, aged thirty-two years, was admitted to the Lari- 
boisiere Hospital at noon on October 5, 1882. A small circular 
wound was found below and a little to the inner side of the left 



BULLET WOUND OF THE STOMACH. 249 

nipple, at the level of the sixth costal cartilage. No counter 
wound existed. He had shot himself about 10 a. m. The 
bullet had not passed through his body, and was found under 
the skin, near the vertebral column, on a level with the ninth 
intercostal space. The patient was pale, difficult respiration, 
pain at the level of the heart, the pulse frequent and small, 
temperature normal, friction sound over the point of the heart. 

October 6: Friction sound gone, pulse less frequent, the 
stomach seems distended. Examination of chest reveals a 
slight dullness at its base on the left side, and respiration dimin- 
ished; no breath sounds and no pneu mo-thorax. A slight 
cough with scant bloody expectoration. Patient remains pale, 
fever slight, temperature never going higher than 100.4^ ; no 
appetite. The patient began to improve, and on the third day 
from this date the patient left the hospital, contrary to the 
advice of Dr. B. Auger, the surgeon in charge. 

October 12: In the afternoon of the third day after leav- 
ing the hospital the patient was re- admitted. At 11 a. m. of 
that day, after drinking freely, he had been taken suddenly 
with severe pain in the region of the stomach. On the next 
day the usual symptoms of peritonitis get in, with difficulty of 
breathing. Respiration, 68; skin moist and hot; temperature 
per rectum, 105° ; increased pleural effusion ; cough slight ; 
flputa not bloody; great distension of the stomach, with pain, 
which was increased by pressure, respiration and the least 
movement of the body. The bowels had been opened with 
medicine, and some blood was passed. Six and one-half ounces 
of dark-colored blood were drawn from the left pleural cavity, 
which relieved the patient. 

October 13: On the evening of this date the patient was 
much worse; pulse very feeble, extremities cold, face cyanoeed, 
and at 3 a. m. of the next morning the patient died in a state 
of coma. 

The postmortem examination made two days afterwards 
revealed a general inflammation of the peritoneum, the mem- 
brane injected and a slight bloody serum present; no false 
membrane, bowels distended with gas. There were nearly ten 
ounces of dark blood in the left pleural cavity, and about one- 
half ounce in the pericardium. The bullet had passed through 
the sixth costal cartilage, through the pericardial sac where 
it is adherent to the diaphragm, perforating this latter structure 
obliquely. Both the anterior and posterior walls of the 
stomach were perforated obliquely to the extent of three 
centimeters. The gastric wound had united by adhesions, 
which were partly broken down. The diaphragm had been 
perforated a second time, and the lower posterior border of the 
left lung wounded ; the ball passing between the ninth and 
tenth ribs. 

The author notes that during the lime the patient was first 



260 THE NASAL COUGH. 

in the hospital, his symptoms were principally thoracic, but on 
his re-admission they were abdominal, and the fatal result was 
attributed to them. If the patient had remained in the hos- 
pital, there is every reason to believe that he might have recov- 
ered. When first admitted there was no evidence of peri- 
tonitis, and the stomach retained the gas which formed the 
second day and for seven days after the injury was abie to re- 
ceive and digest liquid food. The adhesions which had formed 
at the wounds showed signs of being recently torn open. 
There being no false membrane the adhesions indicated that 
the inflammation had not existed long. — Dr. M. E. Deschamps 
in Revue de Chirurgie. 

THE NASAL COUGH. 



The introduction of a surgical instrument into the nose will 
sometimes produce a paroxysm of coughing. From the study 
of this MacKenzie has designated the following reflex regions: 

(1) That there is in the nose a well defined sensitive zone, 
whose irritation, be it from a pathological condition or from 
the introduction of an irritant, will provoke a reflex action. 

(2) That this sensitive zone corresponds with the convex sur- 
face of the turbinated bones. (3) That the reflex-cough is 
brought on by an irritation of this zone. (4) That the posterior 
part of the lower turbinated bone and the corresponding part 
of the septum narium, react most energetically. (5) That the 
reaction is not the same in all individuals. Other observers 
have come to like conclusions. This sensitive zone mav prop- 
erly be called also the tussigenous zone. It corresponds accu- 
rately with the course of the ramus externus of the nervus 
spheno-palatinus and the ramus nasalis of the nervus palatinus 
major of the second branch of the trigeminus, from which the 
irritation is trpnsmitted to the nerves of the respiratory organs, 
and cause clonic spasms of the expiratory muscles, that is, cough 
or tonic spasm of same, which is really the first phase of asthma. 



GERMAN LITERATURE. 
Translated by £. J. WHITEHBAD, A. B , Ann Arior, Michigan. 



ENTERITIS FROM THE TREATMENT OF WOUNDS WITH COR- 
ROSIVE SUBLIMATE. 



The following is an abstiact of an -article in Band XCIX of 
Virchow^s Archiv, by Dr. Fraenkel, of Hamburg. 

In his "Materia Medica," Nothnagel says that corrosive 
sublimate must be used with the greatest carefulness or not at 
all. More recent authors claim that no harm results from the 
use, for days or even weeks, of a solution containing from one 
to five parts of corrosive sublimate in one thousand. 



CORROSIVE SUBLIMATE IN ENTERITIS. 251 

Th^ favorable reports as to its action, especially in gynaeco- 
logical practice, seemed for a time to justify the lattter opinion. 

In a recent number of the Centrablaft fur Oyriakologie is a 
report of a typical case of mercurial poisoning, resulting from 
the use of the sublimate as a disinfectant in a case of retention 
of a portion of the placenta. The injection of four hundred 
cubic centimeters of a solution containing one part of mercuric 
chloride in fifteen hundred of water was followed in a few 
hours by tenesmus and diarrhoea, the evacuations finally becom- 
ing bloody. Death occurred on the tenth day, being preceded 
by ulcerative stomatitis. 

Postmortem examination showed that the intestines were 
hypersemic, and contained numerous grayish-yellow ulcers, 
about one-third of an inch in diameter. The inflammatory, 
ulcerative processs was particularly well-marked in the rectum. 
The epithelium of the lower portion of the small intestine 
could be easily removed. 

In 1884 there were reported three fatal cases from the use 
of corrosive sublimate in treating diseases of women. The fact 
that the employment of the drug as an antiseptic in surgical 
practice, has hitherto been so successful, may cause physicians 
to lose sight of the dangers accompanying its use. 

Generally the first symptom of poisoning is diarrhoea, which 
in mild cases yields readily to treatment with opium. Saliva- 
tion does Qot usually occur. 

In all cases there are inflammation and necrosis of the mucous 
membrane of the large intestine. Occasionally the lower por- 
tion of the small intestine is also afiected. 

Sometimes the surface of the large intestine is found to be 
covered with firmly adherent, dark-gray shreds of epithelium 
that has been separated from the mucous membrane. In other 
cases there may be a diphtheritic infiltration appearing in small 
yellowish patches. If the patient survive for some time this 
infiltrated tissue may be thrown ofi^. 

Occasionally the appearance of the intestine is exactly like 
that observed in severe cases of dysentery. It is seldom that 
the patient lives long enough for such extensive necrosis of the 
intestinal walls to occur, but a postmortem examination, made 
by the author in a case of laparotomy, shows that desquama- 
tion of the intestinal epithelium may take place within twenty- 
four hours. 

There is not sufficient evidence to prove that any character- 
istic nerve-lesions result from the use of corrosive sublimate. 

In the less severe cases of enteritis caused by mercury, opium 
has been found to be of the greatest use. 

The experience of the writer seems to prove: 

(1) That corrosive sublimate is the most valuable of all 
antiseptics, and that, when used with proper care, no evil 
results need follow its use. 



252 DOUBLE SKN8ATION8. 

(2) That there is danger in the immoderate use of the rem- 
edy externally, from the fact that it may cause diphtheritic 
inflammation of the large intestine, and sometimes even of the 
small intestine. This inflammation is clinically manifested 
by tenesmus, pain in the abdomen, and bloody diarrhosal 
discharges. 

(3) That enteritis is most easily produced when there is 
weakness of the heart's action, caused bv fatty degeneration of 
that organ. 

Particularly is this the case when the remedy is applied 
over a large surface, or when it is brought into contact with 
tissue that absorbs readily, such as the peritoneum in laparot- 
omy, or the inner surface of the uterus after parturition. It is 
probable that toxic enteritis may sometimes be partly due to 
the icHosyncrasies of patients. 



ASSOCIATION OF THE SENSE OF TASTE AND SMELL WITH 
COLOR, AND OF SOUND WITH FORM. 



BY RICHARD HILBERT. KONIGSBERO. 



This gentleman reports (Klin. Monatsbk, fur Augenheib 
Kunde) a case which is a valuable contribution to the very 
limited literature of double sensations. 

Mademoiselle A. L., aged twenty-four years, of a healthy 
family, has hitherto been exempt from diseases of the nervous 
system. Since childhood she manifested double sensations, 
which frequently subjected her to reproof and mockery on the 
part of her parents and associates. Although it is thought to 
be hereditary, it must be inferred in this case that her sisters 
and parents were free from double sensations. 

A synchronous perception of color is not excited by every 
smell and taste, but only by those which are especially dis- 
agreeable and repulsive, probably because they make a stronger 
physical impression. Whether delicate and pleasant tastes and 
smells provoke perception of colors she could not be positive, 
although they did so when younger and more impressible. 
They are strongest when attention is not directed to them. She 
cannot produce them voluntarily, nor can they be produced by 
reflex action. Close attention to them weakens the phenomena. 
The taste of a certain kind of beer will excite simultaneously 
the color of brown; of another kind, the color of grey. The 
taste of burnt gravy will cause an ugly brown. The peculiar 
smell of a young dog will also excite brown color. The smell 
of cheese will be associated with brown-green, but the taste of 
old cheese will cause a yellow color. Faint and delicate tastes 
and odors will have lighter colors associated, and intense 
flavors and odors are followed by darker shades. The differ- 



a 



ABSORBING POWER OF HUMAN SKIN. 25$ 

ent shades of brown are the colors most frequently produced, 
and depend upon the degree and intensity of the tastes and 
odors. The smell of a young dog causes a dark brown, but 
after the dog has been washed the brown is lighter. 

Mademoiselle L. has fine musical talents, and when playing 
certain melodies certain forms present themselves to her mental 
vision. These may be of persons she had never seen, and on 
seeing certain persons certain melodies strike her ear which she 
had never heard before. All these sensations were more intense 
in her childhood than since her adolescence, and the recollec- 
tion of them is indistinct and vague. 



ABSORBING POWER OF THE NORMAL HUMAN SKIN. 



Dr. Ad. Better (^Deutscfie Arch, fur Klin. Med.) reports the 
following experiments and results : Salicylic acid was used in 
an unguent made with rectified spirits and vaseline. This wa» 
rubbed upon the healthy skin of the arm, and then cdrefuUy 
bandaged. The freshly voided urine showed with chloride of 
iron, distinct salicylic acid reaction. In order to prove that the 
skin wafi perfectly healthy, an unguent of iodide of potassium 
was subsequently rubbed on the same place, and iodine was 
found in the urine by means of fuming nitric acid and benzine,^ 
but which was not detected prior to the use of the salicylic 
acid. A solution of continuity of the skin does not promote 
iodine absorption. An application of iodide of potassium on 
skin reddened by a sinapism, does not give iodine reaction in 
the urine. But the same application, will dve an iodine reac- 
tion, if the skin has been previously washed with a twenty-five 
per cent solution of salicylic acid in alcohol. The epidermis 
was then thickened and swollen. If an unguent of salicylate of 
soda is rubbed on this place, kept by a bandage for three hours^ 
no salicylic acid is found in the urine. 

In order to test the resorption of tincture of iodine, an arm 
was thrust into a glass cylinder, closed at one end with a rub- 
ber stopper, the other end carefully and closely applied with a 
rubber bandage. By means of a rubber tube the lumes of the 
tincture of iodine were permitted to escape, while the tincture 
itself was being dropped upon the arm. This experiment was 
continued for twenty hours. Iodine was not founn in the urine 
or in the saliva. Similar experiments with mercurial ointment 
led to like results, no mercury being found in the urine. Hence 
the following conclusions were reacned : 

(1) The normal skin has no absorbing function. It does not 
allow the transit of substances in any form, whether in solution^ 
spray, or unguent. 

(2) Only irritating substances, which effect by their intensity 
a solution of continuity, can be absorbed. 



254 CANCER OF THE BREAST. 

CLINICAL LECTURES, 



ABSTRACT OF REMARKS ON CANCER OF THE BREAST. 



BY DONALD MACLEAN, M. D., 

Professor of Surgery and Clinical Surgery in the University of Michigan. 

Reported by W. P. MUNN. 



Here is a tumor of the breast that is unmistakable in charac- 
ter. To describe the appearance and state the condition of the 
parts here involved is to give a typical description of cancer of 
the breast, when advanced to that stage when a malignant 
ulcer is about to be formed. On inspection the breast is seen 
to be considerably enlarged. The upper portion is the part 
most involved. The integument in this region is dark colored, 
and has a rough parched appearance. The nipple is retracted, 
and upon clasping the gland between the thumb and fingers, 
I take. hold of a large hard mass. On examining the other 
breast in the same manner a somewhat similar impression is 
conveyed. The breasts being lax, I am in this way enabled to 
pinch up the gland which feels like a firm morbid growth ; 
but when I place the palm of my hand and fingers flat on the 
right breast all evidence of morbid changes has disappeared, 
and the breast feels perfectly natural : on doing the same on 
the other side, a large hard nodular mass of malignant dis- 
ease is felt beyond all possibility of misake. By this proced- 
ure the smallest growths can be readily detected, which might 
otherwise escape observation. 

Over this mass the skin is unnatural, jcoarse and rough to the 
feel, and when I attempt to pinch it up from the fascia under- 
neath it is found firmly attached. I find also, that the whole 
breast is fixed and cannot be made to move over the structures 
composing the chest wall. On examining the axillary space, 
it is found to be filled with a dense nodulated mass, composed 
of the axillary elands greatly enlarged, matted together, and 
adherent to the deep structures. 

We learn from the patient that for a year she has been 
aware of a growth in her breast. But from the present con- 
dition of the affected parts, it has doubtless existed much 
longer; and upon further incjuiry, she states that last March 
she first noticed a hard lump in her left breast which was then 
the size of an egg. Since then it has grown rapidly and has 
been the seat of pain, which at times is sharp and severe, and 
extends into the shoulder and down the arm. Aside from 
these local manifestations of disease, the patient, who is forty- 
three years old, is in good health, and she states that in every 
other particular she is strong and well. 

Having been seen by several physicians who have declined 
to do anything for her, she comes a long distance and appeals 



CANCER OF THE BREAST. 255 

to US for relief. She comes here full of hope and confidence that 
we can do something for her. This is a mental condition that 
in most cases is a great aid to the surgeon, but in some it 
may add greatly to his responsibility. She wants relief and is 
willing to submit to any course we may determine upon, know- 
ing that the disease has passed beyond the time when her opin- 
ion should be allowed to determine the choice of procedure. She 
knows the nature of her disease, and for the future she sees two 
very different prospects, and hopes by our aid to avert the one 
and secure the other. Being well preserved and in good gen- 
eral health, could this disease be removed, it is reasonable to 
expect that she would live many years to enjoy the pleasures 
and engage in the duties of life ; but if we cannot give her 
this boon a few months will end her life, in a painful death. 
It is for us to determine whether we will attempt to secure 
for her the former result, and upon what grounos are we to 
base the decision that is to determine this important question ? 
It has been my experience, and from the statistics found in 
the literature on the subject, we learn that it has been the 
experience of others, when the fact of a cancer in the 
breast is established beyond a doubt, that it is in most cases 
practically incurable; and that when it has existed until the 
lymphatic system has become involved and the glands indu- 
rated, the chance for success from an operation is even more 
doubtful. 

When I was a student I was taught that cancer of the breast 
would invariably return if removal was delayed until the 
axillary glands were involved. But in the large school of expe- 
rience I have learned that this rule will not hold good in every 
case. I have operated upon such cases, and have seen them 
get well and remain well, out all did not end so favorably. In 
some the disease returned soon after the operation, while in 
others there was no evidence of return for several years, and 
during that time the patients lived free from any physical 
suffering, und relieved of all mental distress of the aread of 
their terrible fate. I repeat there is no general law by which 
the result of an operation of these cases can be determined. 
What then, are the conditions of the disease and of the patient 
' that is to determine whether a case is favorable, or unfavora- 
ble for an operation? Tables and statistics do not answer the 
question for us : opinions formed from these sources are very 
general, and do not meet all the conditions that are encount- 
ered in individual cases. In cases on the border land of suc- 
cess and failure there are considerations to be made, that 
lie beyond the pale of general rules and general terms. The 
satisfying evidence and data from which the answer is to be 
made, must be found in the case itself 

To determine the course to be taken here, it is necessary to 
carefully weigh all the symptons and conditions. Let tnese 



256 CANCER OF THU BREAST. 

considerations be directed first to the tumor itself. The breast 
is large but its size is comparatively of little moment, and need 1 

not enter into the question of operating. Its deep attachments ' 

are of far more importance. The amount of disease in the 
gland is well marked and prominent, but its outline is not 
well defined and distinct ; the malignant mass gradually fades 
into the healthy tissue; it is infiltrated into all the surround- 
ing tissues, rendering it impossible to determine how much of 
these structures may be involved. But a feature of still greater 
importance and a condition even more unfavorable, which in 
reality is only a continuation of the former, is the invasion of 
the skin by the disease. Here is an entirely distinct tissue 
from the gland, involved in the disease, which from its extent 
and continuity cannot be extirpated like the gland. To re- 
move all the diseased and infiltrated skin, a procedure which 
must be done if any operation is made, would leave a large 
open sore to be healed by granulation, which in this case I 
fear would not be accomplished, but would hasten the formation 
of an extensive malignant ulcer. The muscle underneath is sdso } 

involved — to what extent is not possible to determine. This 
tumor which was at first local and confined to the gland; 
and which could then have been most radically removed by 
excision of the gland, is now incorporated with the tissues 
underlying and superficial. The involvement of the glands 
in the axilla to the extent found in this case is even a more 
unfavorable condition, which not only renders the operation 
dangerous, but removes, in my opinion, all reasonable hope of 
ultimate success or material relief to the patient. The re- 
moval, in these circumstances, of all obviously diseased struc- 
tures within our reach, supposing such a result to be possi- 
ble anatomically, would still fall far short of accomplishing 
the end which we have in view. In fact, with the disease so 
feir advanced, its entire removal is not possible. Experience has 
proven that the tissues, wide of any visible evidence of disease^ 
IS the seat of degenerative processes which continue, and the 
cancer goes on invading and destroying the structures uninter- 
ruptedly. After a most thorough and careful operation has ' 
been performed the disease is liable and likely to return in 
contiguous structures, and to appear in parts remote ; the 
opposite gland may be the next region to be attacked : the 
liver, mesenteric glands, the omentum, or any organ may very 
soon become diseased. 

While these fundamental facts and considerations are suffic- 
ient to discourage any operation and destroy all hope of re- 
moving this loathsome disease, our duty toward the patient is 
not ended. We have another point to consider. There is no 
doubt in my mind of the ultimate issue, whether she ie left 
alone, or whether an operation is performed. In either case the 
disease will soon terminate in the death of the patient. If we 



CANCER OF THE BREAST. 257 

cannot avert what is an inevitable result, cun we by an opera- 
tion render more comfortable the life that must be passed ? 
Can we by an operation relieve her of the bodily suffering and 
mental anguish that she must otherwise endure? It is the 
surgeon's duty to settle these questions which deeply interest 
both patient and friends. The facts and circumstances in the 
case must again be carefully considered. 

On the one hand is the appeal of the patient, to free her of 
a disease, which from its beginning to its end, is one source 
of constantly increasing pain, distress and dispair. Slowly 
in some, — more frequently a rapid course marks the tumor's 
growth, — all adjacent structures become infiltrated with the 
malignant germs, the skin disintegrates, freed of any resistance 
the growth forms foul fungoid excresences ; the ulcer painful 
and offensive to the patient, she becomes a fearful charge to 
her friends, until death closes the scene. A more distressing 
condition cannot be conceived. 

On the other hand is the operation, with all the dread and 
risk that attend it. The greatest success hoped to be attained, 
would be a short respite from the condition already described. 
During that brief period there would be enjoyed an apparent 
immunity from the disease. The patient is relieved of the 
burden that pained the flesh and harrassed the mind, and 
feels that she is restored to health. The constant fear of 
speedily approaching, yet painful, lingering death, is lost to 
sight, and she believes that she has been restored to her friends 
and ifamily. This is a sweet but fleeting delusion, for soon 
the disease returns with increased destructiveness, the newly 
created hopes are blasted and dashed to the earth ; happiness 
turned to sorrow ; confidence ends in disappointment ; each 
more deep on account of the faith that had been falsely 
created. 

The results of the reaction do not end with this. The friends 
believe that the operation made the disease more active, and not 
being able to comprehend the difference between an operation 
performed for temporary relief and radical cure, regard it a. 
failure, and become convinced that any cancer operated upon 
at any period of its history will become aggravated and more 
rapidly fatal, and through this unfavorable reflection on Sur- 
gery, would be the means of deterring others who might be 
permanently benefitted by resorting to operative measure. 

My duty to this patient and to all concerned is to explain 
the situation, presenting carefully both sides, and then inform 
her that in my opinion there is nothing to be gained by an 
operation. She has made her appeal too late, the best that can 
be done now is to caution her against quacks and cancer van- 
dals, and to give her such instruction as will best mitigate 
the terrible and inevitable ordeal that is to continue through 
the short remainder of her life. 
Q 



258 CANCER AND ABSCESS OF BREAST. 

HOSPITAL REPORTS, 



MICHIGAN STATE HOSPITAL. 



SURGICAL CLlNia 

UNDER DONALD MACLEAN. M. D.. 
ProfesBor of Surgery and Clinical Suigery in the University of Michigan. 

J. W. BOSMAN, Clinical Clerk. 



CANCER OF THE BREAST; ENLARGED AXILLA.RY GLANDS 

PROGNOSIS UNFAVORABLE. 



Mrs. M,, aged forty-three years, Leslie, Michigan. Admitted 
to Hospital February 18, 1885. Since last March the patient 
has experienced some trouble with her left breast. At that 
time a large dense tumor was discovered. The presence of pain 
first directed her attention to the region. Does not know how 
long the growth may have existed. 

The breast is now greatly enlarged, painful to the touch, ^ 

and the skin dark colored. The axilla filled with enlarged 
indurated glands. The patient has had four children. With 
the exception of the pain and annoyance caused by the weight 
and large size of the breast, she is in good health. Pain is not 
confined to the disease, but extends into neck and arm. 

Diagnosis, — Cancer of breast, and prognosis unfavorable. 

From the advanced stage of the disease, and the desire of 
the patient for him to decide regarding an operation, Professor 
Maclean recommended that she remam in the Hospital for a 
few days, that the disease might be more carefully examined 
before he would decide on the advisability of an operation. 

February 22: Patient carefully re-examined, when it was 
determined not to operate. Patient advised to go home, and . 
counseled to avoid all operations and caustic applications. 

ABSCESS OF BREAST : EXCISION. 



Mrs. William C, aged forty-four years. Admitted to hospital 
Tebruary 16, 1885. The patient has borne eleven children. 
Ten of them were nursed from the left breast. While she was 
nursing her first child the right breast inflamed, suppurated, 
and "broke," and continued to discharge for several years. 
The breast has been healed for a number of years, but for some 
cause it has always been a source of uneasiness to her. It now 
pains her, is tenaer, and she fears that it has become the seat 
of a malignant growth. 

The tumor that is felt by laying the hand flat ^against the 
ibreast is hard and well defined. 

Diagnosis. — ^The presence of a tumor in the breast is suffi- 
cient to excite suspicion. If the tumor is hard, not movable. 



CHRONIC ABSCESS OF BREAST. 259 

and the seat of pain, and occurring in a woman forty-four 
years of age, the hne of treatment to be adopted is sometimes 
more easily determined than the diagnosis. This growth has 
some of the features of cancer, but its history does not point to 
malignancy. When cancer of the breast once ulcerates it never 
heals. There is no doubt about the nature of the tumor. It 
is the remains of an old abscess, which is again becoming 
inflamed. It is painful and a constant source of irritation to 
body and mind, and occurring in a woman of this age the best 
thing to do is to remove it. 

OperaJtion, — On completing the incision two small pockets of 
pus were cut into. The glands, when removed and divided to 
ascertain the character of the growth,' seemed to be only a mass 
of cicatritial tissue. A number of vessels were bleeding quite 
freely, which were secured with catgut ligature cut closely at 
the knot. 

February 20: The wound up to this time had done remark- 
ably well, and seemed as if it had united by first intention. 
This morning the inner angle of the wound was swollen, and 
upon separation of the edges a considerable quantity of pus 
and serum escaped. The cavity was thoroughly washed out 
with carbolized water. Temperature, 103°. 

February 21: The febrile symptoms subsided. Discharge 
healthy and small in quantity. 

February 23: Stitches removed. Wound all healed but 
inner angle. Feels well. Appetite good. 

February 25 : Wound practically healed. Dismissed. 

CHRONIC ABSCESS OF BREAST: EXCISION.- 



Mrs. H. 0., aged twenty-two years. Entered Hospital March 6, 
1885. When fifteen years of age patient worked as a domestic 
and was much exposed to cold, which brought on an attack of 
fever. She became pregnant soon after marriage. Three months 
before her confinement her right breast became painful and 
swollen. This was twice lanced and afterwards opened a num- 
ber of times at different places. Her child was not nursed. The 
openings in her breast did not heal, and continued to dis- 
charge for three or four months. During her second term of 
pregnancy her breast became much worse, and the pain very 
severe, and the -swelling even worse than the previous attack. 
It was again lanced several times. At each time a firee quantity 
of pus was evacuated. Since then the breast has continued to 
discharge. During her menstrual periods the pains in her 
breast are much worse. The left breast is healthy and natural. 

March 7 : Patient examined before the class. From the long 
standing disease, and the useless condition of the breast, excis- 
ion was recommended, and immediately. This measure would 
relieve her of her present painful and unpleasant condition, and 



260 SCIRRHUS — STATE MEDICAL SOCIETY. 

protects her from the dangers of future malignant disease, 
which would most likely appear sooner or later. 

March 9: Operation of excision performed. The gland struc- 
ture was all destroyed, and the breast was composed of magses 
of inflammatory products, and being vascular a number of ves- 
sels were ligatured. 

March 19: The wound healed rapidly, and is now closed and 
solid, excepting where the ligatures came out. 

March 23 : Wound healed and patient dismissed. 

SCIRRHUS OF RIGHT BREAST: OPERATION. 



Mrs. G. D., aged forty-five years, Whitehall, Michigan. 
Entered hospital, April, 1, 1885. About one year ago she first 
noticed a lump in right breast about the size of a hickory nut. 
The growth remained small and grew but very little, until a few 
months ago when it became the seat of sharp irregular pains, 
after which it began to increase and continued to grow rapidly 
to the present time. The pain is now less sharp, but more con- 
stant, and is confined to the tumor. The lymphatic glands in 
the axillary cavity are enlarged. All glands do not seem to be 
involved. As far as can be determined the infection is confined 
to the lower chain, along the inferior border of the pectoralis 
major muscle. 

Diagnosis. — Scirrhus of breast. Immediate operation recom- 
mended. The involvement of the axillary glands makes a 
favoral prognosis somewhat doubtful. 

Operation. — Patient put under the influence of an ansesthetic, 
and entire breast, with superficial fascia and underlying muscle, 
removed. Two glands were found enlarged and removed. After 
careful search no further evidence of disease could be detected. 
The wound was accurately fitted. 

April 10: Wound nearly all healed by first intention. Slight 
healthy discharge from the axillary end of wound. 

April 12 : Wound nearly entirely healed. Discharge healthy 
and nearly stopped. Patient feels very well. Appetite good; 
bowels regular. 

April 15 : Dismissed. 



EDITORIAL PERISCOPE. 



STATE MEDICAL SOCIETY. 



The meeting to be held at Port Huron, June 10 and 11, 
promises, from the number, variety, character, and authorship 
of the papers, to be the most instructive and profitable since the 
organization of the society. Through the untiring efforts and 
energy of the president, and the chairmen of the various com- 



STATE MEDICAL SOCIETY. 261 

mittees, the titles of papers were secured sufficiently early to 
have the discussion on each opened by a paper, which will be 
followed by general discussions. 

A number of distinguished specialists have been invited to 
read papers and take part in the general discussion. Among 
the number who have consented to be present are: Dr. William 
Goodell, of Philadelphia. Professor of Obstetrics and Gynaecol- 
ogy in the University of Pennsylvania; Dr. J. Reeves Jackson, 
of Chicago, Professor of Practice of Medicine, and General 
Pathology,* College of Physicians and Surgeons, Chicago; Dr. 
Hingsten, of Montreal, and Dr. Strong, of Cleveland. 

The Executive Committee have so arranged that the social 
feature of the meeting will be of the most pleasing character. 

The preliminary programme is out and contains the follow- 
ing titles and information : 

ADDRESS BY THE PRESIDENT. DONALD MACLEAN. 

STATE SANITATION.- v. C. VAUGHAN. Chairman, vice H. M. HURD. declined on 

account of ill health. 

{l) A Paper on the Quantity of Alcohol Given off in Bread- 
baking and Remaining in Fresh and Stale Bread, by Dr. 
A. B. Prescott. Discussion by Dr. R. H. Stevens. 

{2) A Paper on Legislation to Obtain the Publication of Con- 
stituents upon the Labels of Proprietary Medicines, by Dr. 
A. B. Prescott. Discussion opened by Dr. H. B. Baker. 

3) A Paper on the Comparative Value of Some Antiseptics 
Determined Experimentally, by Dr. N. H. Williams. 

4) A Paper on Practical Disinfection, by Dr. V. C. Vaughan. 
Discussion on both papers opened by Dr. A. B. Lyons. 

OBSTETRICS.— E. P. CHRISTIAN. M. D., Chairman 

1) A Paper on Tubal Pregnancy, by Dr. J. H. Bache, M. D. 
Discussion by Dr. Manton and others. 

2) A Paper on the Treatment of the Perinaeum, by W. P. 
Manton, M. D. Discussion by Drs. Dunster and Kinne. 

3) A Paper on Complete Atresia of Vagina and Loss of 
Urethra and Base of Bladder, bv Dr. T. J. Sullivan. Dis- 
cussion by Drs. Carstens and C. H. Leonard. 

4) A Paper on Sterility, by Dr. C. H. Carstens. Discussion by 
Drs. G. K. Johnson and A.' F. Whelan. 

5) A Paper on Primary Cancer of Vagina, by C. Henri Leon- 
ard. Discussion by Drs. N. W. Webber and C. W. Morse. 

6) A Paper on Post-Partum Haemorrhage, by Dr. A. F. Kinne. 
Discussion by Drs. Hamilton E. Smith, Wm. Parmenter, 
and Shepard. 

OPHTHALMOLOGY.— C. J. LUNDY, M. D.. Chairman. 

1) A Paper on Hygenie of Students' Eyes, by Dr. H. B. 
Hem en way. Discussion by Dr. R. J. Kirkland. 

2) A Paper on Iritis, its Relation to Certain General Diseases 
and its Treatment, by Dr C. J. Lundy. Discussion by Dr. 
L. Connor. 



262 STATE MEDICAL SOCIETY. 

TEMPERANCE QUESTION.— A. B. PALMER. M. D.. Chainnui. 

(1) A Paper on Physiological, Pathological, and Therapeutical 
Action of Alcohol, by the Chairman. Discussion by Dr. A, 

F. Whelan. 

PRACTICE OF MEDICINE.— D. W. C. WADE, M. D., Chairman. 

(1) A Paper on Pood for Diabetics, by Dr. J . A. Post. Re- 
marks by Dr. V. C. Vaughan. 

(2) A Paper on Gems in Medical Practice, by Dr. Wm. H, 
DeCamp. Discussion by Dr. E. L. Shurly. 

(3) A Paper on the Microscope in Medicine, by Dr. Chas. H. 
Stowell. Discussion by Drs. J. A. Post, Eugene Boise, and 
Mina Logue. 

(4) A Paper on Migraine, by Dr. 0. B Campbell. Discussion 
by Dr. A. R. Smart. 

(6) A Paper on Abscess of Cerebellum and Complications, by 
Dr. C. George. Discussion by Drs. Munson, Flinterman, 
and Burr. 

(6) A Paper on Sudden Death after Continued Fevers, by Dr. 

G. P. Andrews. Discussion by Dr. G. K. Johnson. 

(7) A Paper on Treatment of Vomitting with Large Doses of 
Oxalate of Cerium, by Dr. W. R. Chittock. Discussion 
opened by Dr. S. P. Duffield. 

SURGBRY.-J. T. MAIN, M. D.. Chairman. 

(1) A Paper on the Anaesthetics of the Future, or Coming 
Aneestnetics, with history of all anaesthetics to the present 
time, by Dr. S. P. Dumeld. Discussion opened by Drs. 
Wade and Wm. Brodie. 

(2) A Paper on Surgical Cases and Clinical Notes on the same, 
by Dr. I. E. Brown. Discussion to be opend by Dr. H. 0. 
Hitchcock. 

(8) A Paper on External Perineal Urethrotomy, with report of 
cases, oy Dr. H. 0. Walker. Discussion to be opened by 
Dr. E. L. Kimball and J. B. Griswold. 

(4) A Paper on the Origion of Cancer and Tumors, by Dr. T. 
A. McGraw. Discussion by Drs. McCoU and Book. 

(5) A Paper on the Management of Diseases Incident to 
Hypertrophy of the Prostate, by Dr. H. C. Wyman. Dis- 
cussion by Dr. T. A. McGraw. 

(6) A Paper on Plaster of Paris in the Treatment of Fractures, 
by Dr. H. McColl. 

MISCELLANEOUS. 

(1) A Paper on Medical Examination of Applicants for Life 

Insurance, by Dr. H. F. Lyster. Discussion by Dr. H. 0. 

Walker. 

Any member having special information or specimen or 
case bearing upon any of the subjects enumerated in the pro- 
gramme are requested to come prepared to submit them in 
connection with the discussion on the appropriate paper. 

Papers in preparation, and not mentioned in this pro- 



THE BROMIDE OP ETHYL. 263 

gramme, if submitted to the Chairmen of the appropriate com- 
mittees before or at the opening of the session, will be consid- 
ered by the Society, if time permits. 

Special papers, and papers reported in the different sec- 
ions, may be read* at any time, at the pleasure of the Society ; 
but reports from the Chairmen of the committees will be made 
in accordance, as far as practicable, with the programme. 

The Secretary regrets his inability to procure a complete 
list of all the papers to be read betore issuing this notice, 
which has been delayed in order to do so. 

The Secretary is instructed by the President of the Society 
to state that the following distinguished visitors will be present 
as guests of the Society, namely : Dr. Wm. Goodell, of Philadel- 
phia, Dr. Hingsten, of Montreal, Dr. Strong, of Cleveland, and 
Dr. J. Reeves Jackson, of Chicago. These gentlemen will con- 
tribute something, either in the way of papers or speeches. 
Dr. Hingsten, if opportunity offers, will contribute a paper on 
" Stone in the Bladder ; " Dr. Strong, if opportunity offers,, 
will contribute a paper on the '* Climacteric in the Male." 

At the conclusion of the meeting an excursion by boat will 
take place, concluding with a banquet at the Oakland Hotel 
at Saint Clair. 

The order of exercises will be arranged by the Executive 
Committee in a supplementary programme to be furnished at 
the opening of the meeting. Authors of papers will be re- 
quested to read them at the meeting in abstract^ or at least not 
to occupy more than twenty minutes in reading such papers^ 
It is expected that speeches will not be more than ten minutea 
in length, and that no one will speak more than once on the 
same subject. 

Ample hotel accommodations will be provided at reduced 
rates. Geo. E. Ranney, Recording Secretary. 

Lansing, May 19, 1885. 



THE BROMIDE OF ETHYL AS AN ANAESTHETIC IN LABOR. 



A paper was read with this title by Dr. Montgomery at the 
April meeting of the Obstetrical Society of Philadelphia. 

Reviewing the various anaesthetics, he said that chloroform 
was objectionable in that it caused inertia uteri and tedious 
labor, and increased the danger of post-partum haemorrhage. 
The rdative infrequency of fatal cases under its use in surgical 
practice, and the still greater rarit}'' of serious results from its 
use in obstetrics, did not warrant its habitual use. The use of 
ether in natural labor was infrequent, because to relieve pain 
the patient must be profoundly etherized. Partial etherization 
only destroyed the aoility to bear pain without obtunding sen- 
sation. Besides, Tait had demonstrated that ether passed rap- 
idly into the circulation of the foetus, endangering its existence. 



264 RESECTION OF THE INTESTINE. 

The mixture of nitrous oxide and air advocated by Klikowitsch 
required a special apparatus and was unwieldy. The ideal 
anaesthetic was one that was safe for both mother and child, 
certain in its effects, rapid in relieving pain without producing 
loss of consciousness, and the effects of which passed off quickly. 
All these demands were met by the bromide of ethyl. He 
mentioned one hundred and twelve cases in which it had been 
used, twenty-nine of which were in his own practice: none of 
the mothers died, and but three of the children. In none of 
the latter could death be attributed to its use. It was admin- 
istered during the second stage of labor by placing a napkin 
wet with a few drops of the ethyl over the face at the advent 
of each pain, and withdrawing it as the pain subsided. Unless 
a drachm was used, the sensation of pain was obtunded with- 
out arresting consciousness. The process of labor was carried 
forward vigorously and quietly, the patient ready to exert or 
withhold voluntary aid, as her attendant might direct, and the 
expulsion of the head was attended by no greater pain than 
accompanied the evacuation of obstinately constipated bowels. 
His experience did not lead him to believe that its use would 
induce inertia uteri or increase the tendency to post-partum 
haemorrhage. 

RESECTION OF THE INTESTINE. 



In a valuable paper read before the Harveian Society of 
London {British Medical Journal)^ Mr. Frederick Treves stated 
that while the operation in question dated from about the year 
1878, many isolated instances of resection of the intestine had 
been recorded much earlier. About one hundred and fifty 
cases are now on record. The operation is regarded applicable 
to both the small and large intestine. In the cases recorded it 
has been performed for the following conditions: (1) Simple 
and epitheliomatus strictures; (2) Neoplasms other than can- 
cer; (3) Extensive matting of the bowels, involving obstruc- 
tion ; (4) Irreducible intussusception ; (5) Gunshot and allied 
injuries of the bowel; (6) Gangrenous gut in hernia; (7) 
Faecal fistula. Mr, Treves thinks it might also be applied to 
certain perforating ulcers of the intestine. The operation im- 
plied merely the application to the intestine of a simple and 
recognized plan of treatment which was adopted in correspond- 
ing conditions to other parts of the body. In most of the 
affections named, enterotomy and colotomy ofiered the only 
other means of treatment; they gave temporary relief only, 
leaving the cause of the disturbance untouched. In an- 
other series of cases, the removal from the body, as early as 
possible, of gangrenous and putri'i parts was obviously indi- 
cated. Lastly, the mortality in gunshot wounds of the bowel 
was so exceedingly high, that the operation had in these cases 



STRETCHING OF LINGUAL NERVE. 265 

great claims to consideration. The naanner of operating was 
illustrated by euterectomy, and there were two procedures. 
In one, the divided ends were united by sutures immediately 
after the resection ; in the other, the part was excised, and an 
artificial anus established, which was closed after a time by a 
second operation. The abdomen having been opened, the loup 
to be excised was drawn out and placed upon a sponge. The 
gut above and below was secured, either by the fingers of an 
assistant, or by special clamps introduced by Rydygier, Bishop, 
Makins, and Treves. The gut was excised, and with it a tri- 
angular piece of the mesentery, the cut edges of the latter 
being united by a few points of suture. If the bowel were to 
be united, the best material was Chinese twist, applied by 
Hagedorn's needle and needle-holder. Of the various sutures, 
the Czerny-Lembert was the best. A row of sutures was intro- 
duced involving only the mucous membrane, and a second row 
involving only the peritoneum. About fifteen points of suture 
were needed for the first row, and about twenty-five for the 
second. Of the two methods, the second was by lar the better. 
Most of the patients were not in a condition to bear a pro- 
tracted operation. Moreover, the first method did not give 
complete relief to the obstruction, did not insure emptying the 
bowel above the obstruction, and involved great risk from faecal 
extravasation, owing to the distended state of the gut, and to 
the great risk of gangrene along the suture-line. Moreover, 
there was great difficulty in uniting the much dilated upper 
segment to the shrunken segment below. The mortality of the 
operation was discussed, its simplicity urged, and a hope was 
expressed that its application would be more widely extended. 



STRETCHING OF THE LINGUAL NERVE FOR NEURALGIA. 



There is reported in the British Medical Journal by Mr. 
Clement Lucus, an operation for the relief of extreme neuralgia 
of the tongue by stretching the lingual or gustatory nerve. He 
pointed out what he believed to be an original observation: 
that if the tongue be seized by the tip and drawn forcibly out 
of the mouth and on one side, the lingual nerve of the opposite 
side is made to stand out as a firm band beneath the mucous 
membrane on the side of the tongue, where it can be readily 
felt and secured. The operation was performed as follows: A 
suture was placed through the tongue to the right of the sep- 
tum, by means of which the organ was drawn forcibly out and 
to the left side. A sharp-pointed hook was then passed under 
the nerve to fix it. The mucous membrane was then divided 
over the nerve for about half an inch, so that it could be readily 
Been, and an aneurism-needle having been passed immediately 
under the nerve, the sharp hook was withdrawn. The nerve 
was in this way easily reached and stretched. 



266 CONDENSATIONS. 

CONDENSATIONS. 



The cholera is stated in a press despatch to have broken 
out again in Cairo, seven deaths having occurred from the dis- 
ease up to the date of message, and later dispatches confirm its 
re-appearance in Marsailles. 

When the peculiar stabbing or pricking sensation and slight 
induration announce the commencement of a boil, it will not 
be further developed if the skin over it be superficiallv scraped 
with a small knife, so that a drop or two of blood may be 
pressed through the epidermis: given on statement of Dr. 
Sieven, of Saint Petersburg. 

A SANITARY convention will be held at Ypsilanti, Michigan, 
under the auspices of the State Board of Health, on June 30 
and July 1. The object of the meeting is to discuss the water 
supply, drainage and sewerage, causes of malaria, and other 
questions pertaining to a better sanitary condition of that city. 

The University of Pennsylvania has adopted a series of rules 
in reference to vivisection. They fall far short of what the 
anti-vivisectionists wanted, but are sufficiently restricted to 
prevent unauthorized and improper experimentation. The 
regulations adopted are practically those recently promulgated 
in Germany. 

A VERY simple remedy in caees of chronic diarrhoea, especi- 
ally in phthisical patients, which is highly recommended, is 
white of egg. The whites of eight or ten eggs beaten up in a 
pint of water so as to form an emulsion, to which may be 
added a few minims of laudanum and a little flavoring extract. 
The entire amount to be taken in twenty-four hours. 

The Governor of Indiana has signed a bill providing that 
any person desiring to practice medicine or surgery, shall pro- 
cure from the clerk of the circuit court a license, to secure 
which he must file an affidavit showing his graduation from 
some reputable medical college, or else he shall present the 
affidavits of two reputable freeholders that he has practiced 
medicine in the state for ten years 

Naphthalin is used in the treatment of typhoid fever at 
Rossbach's clinic {Deutsche Medizinal Zeitung). It is given in 
fifteen grain doses, the daily amount sometimes reaching to 
between ninety and one-hundred grains. In half the cases the 
fever was arrested within ten days from its beginning. In nearly 
every instance the duration of the disease was shortened. In 
only one case unpleasant symptoms were observed, a slight 



CONDENSATIONS. 267 

cerebral disturbance occurring after the patient had taken one 
hundred and five grains. 

From evidence which is almost incontrovertible, the conclu- 
sion must be drawn that the recent terrible epidemic of 
typhoid fever in Plymouth, Pennsylvania, was due to the con- 
.tamination of the water in the reservoir by the stools of a 
single patient with typhoid fever, which were thrown on the 
snow during the montns of January and February. The latter 
part of March the weather was warm, and these deposits were 
washed into the reservoir, which contained but little water, and 
from which the town at this time (March 26) began to draw 
water. April 5 the first cases appeared, and before April 19 
there were nearly three hundred cases. 

Dr. Herbert, of Garlsruhe, gives in CentrelhaJley an 
account of his examination of a bottle of French mustard, in 
which the cork was found to be coated on the inside with a 
thick saline crust of acetate of lead formed by the action of 
the vinegar on the foil with which the bottle was capped. Such 
facts as this should be taken into consideration when searching 
for an obscure cause of disease ; for there is reason to believe 
that poisons often find their way into the system through 
the food, producing effects which, if slow, nevertheless surely 
undermine the health. It is, indeed, a possible question to 
how great an extent the lead solder used for sealing tin cans, in 
which fruit or vegetables is preserved, is responsible for the 
frequent cases of habitual constipation that abound. 

The treatment of acute laryngitis, which Dr. John M. 
Keating has found very efficacious, is given by that gentleman 
to the profession through the Archives of Pediatrics : In con- 
iunction with a hot foot-bath, the temperature of the water as 
hot as the hand can bear with comfort, and the feet afterwards 
wrapped in flannel or canton flannel night-drawers with the feet 
of extra length and sewed up at the extremities, he prescribes 
the following in a half a tumblerful of water : 

B. Tinct. aconit. rad gits, iij 

Spts. setheris nit. dulc ^\ 

Syr. scillse comp 3j 

This is given in frequently-repeated desertspoonful doses 
throughout the night. A soft handkerchief wrung with ice- 
cold water and surrounded by a piece of flannel is applied. 
If the cough continues and becomes bronchial, it is well to pro- 
duce a certain amount of counter-irritation of the chest. 
Ordinary camphorated oil is about the best. In addition to 
the ipecac, we should recommend small doses of castor oil, the 
object being to relieve the congestion of the bronchial mucous 
membrane by acting on the intestinal mucous membrane. 



268 NEW PUBLICATIONS. 

NEW PUBLICATIONS. 

MICKO-CIIEMISTRY OF POISONS, INCLUDING THEIR PHYS- 
IOLOGICAL, PATHOLOGICAL, AND LECJAL RELATIONS. 
WITH AN APPENDIX OF THE DP:TECTI0N AND MICRO- 
SCOPICAL DISCRIMINATION OF BLOOD: Adapted to the use 
of the Medical Jurist, Physican and General Cfiemist. By Theo- 
dore G. Wormley, M. D, Ph. D.. LL. D., ProfeFsor of Chemis-- 
try and Toxicology in the Medical Department of the Univer- 
sity of Pennsylvania. With ninety. six illustrations upon steel. 
Secoad edition: 8mo: seven-hundred and eightv-four pages. Price 
in cloth, $7.50. Philadelphia: J. B. Lippincott & Co., 1885. 

From the title, " Micro-Chemistry of Poisons," the scope of 
this work is understood to be " the study of the chemical prop- 
erties of poisons as revealed by the aid of the microscope." 
While this theme constitutes the principle element of the 
treatise, it is not limited to this branch of the science. The 
work is written in two parts. Part first deals with the 
inorganic poisons, and part second with vegetable poisons. | 

These agents are classified with reference to their chemical or 
botanical relations; each substance being separately considered 
as to its history and chemical nature ; physiological effects ; 
special chemical properties; compounds; history and varie- 
ties; symptoms; period when fatal ; f[ital quantity ; treatment; 
postmortem appearances ; general chemical nature ; solubility ; 
special chemical properties^ quantitative analysis. 

The first edition of this work has been a book of reference 
and authority for medico-legal experts, and text-book for phy- 
sician and chemist. Thorough revision which it has received, 
and the many important additions that have been made, brings 
the second edition greatly enlarged, and rendered the more ' 
valuable. Many illustrative cases, chiefly American, and new 
texts and methods of recovery of poisons from organic mixture; 
an entirely new chapter on gelse.Tiium poisoning, and an ap- 
pendix on the nature, detection, and microscopic descrimina- 
tion of blood, are special and important additions. Other sub- 
jects added are poisoning by potassium chlorate; postmortem 
diffusion of arsenic ; arsenic in medicines, in fabrics, and in 
glass ; Dragendorff's method for the recovery of vegetable 
principles; nature of ptomaines; and the preparation, prop- 
erties and recovery of jervine. 

Poisoning from gelsemium are becoming frequent in a ratio 
with the increase in the use of the article. Gelsemime, the 
alkaloid of yellow jessamine, is an exceedingly active poison. 
In twenty-five cases of gelsemium poisoning collected by the 
author, thirteen proved fatal, and the fatal period varied from 
one hour to seven hours and a half. The fatal quantity cannot 
yet be indicated. Twelve minims of the fluid extract proved 
fatal to a boy, aged three years. A physician who took re- 
peated doses at short of fifteen minims, manifested symptoms. 



NEW PUBLICATIONS. 269 

of poison after the fourth dose, and was dead in less than four 
hours. 

The symptoms produced by poisonous doses as described 
by Professor Wormley are: Impaired sight, double vision, 
sometimes total blindness, falling of the upper lids, face con- 
gested and lips livid, pupils dilated — usually insensible to 
light, eyes fixed or staring, falling of lower jaw, mouth some- 
times wide open, speech is impaired or lost, the gait is stag- 
gering, the skin moist and warm with occasionally free per- 
spiration ; the pulse is small, feeble, irregular, and intermit- 
tent, but it has been observed full and strong ; there is great 
muscular relaxation with general prostration and diminished 
sensibility, and the extremities are cold ; the breathing is slow, 
labored, spasmodic, and sometimes stertorous ; violent spasms 
of the throat, resembling those of hydrophobia, have been 
present in a few cases; the mind usually remains clear, but un- 
consciousness has been present even when recovery followed. 
No chemical antidote for this poison yet known. In several in- 
stances the application of electricity has been found beneficial. 

The author cites a number of cases of poisoning, from 
chlorate of potassium. This salt of potassium has generally 
been regarded as non-poisonous, and is so freely used, that it 
has become a common domestic remedy. Its similarity in 
appearance to the still more common salts of magnesia has 
occasioned several fatal mistakes. According to M. Marchand 
the poisonous action of chlorate of potassium, is due to its 
oxidizing action upon the haemoglobin of the blood, by which 
the corpuscles acquire a great tendency to agglutinate. Thus 
modified, the corpuscles accumulate in the different organs, 
but more especially in the kidneys, where they form brownish 
conglomerate masses. 

The composition and detection and discrimination of blood 
are very carefully and methodically considered. A few num- 
bers not usually accessible will be of interest. According to 
Vierordt, and also Welcker, our cubic millimetre of normal 
human blood contains about five million red corpuscles. Ac- 
cording to these estimates, which have been confirmed by more 
recent observers, a single grain of human blood contains about 
three hundred and twenty-five million corpuscles. The weight 
of a single corpuscles may be stated approximately at one- 
eight hundred millionths of a grain, or, according to Harting, 
at one-thirteenth million one hundred and fourteen thousandth 
of a milligramme. 

The subject of the appendix is treated under four headings: 
(1) General Nature and Properties of Blood; (2) Chemical 
Tests for Blood ; (3) Optical Properties of Blood. The average 
size of mammalian corpuscles, have been found by the author, 
the same as stated by several observers, that, as a general 
result, the blood-corpuscles on drying in very thin layers on a 



270 NEW PUBLICATIONS. 

glass slide, undergo no appreciable change in diameter, but 
that slides of human blood have been examined in which no 
corpuscles were found of less diameter than about one-thirty- 
six hundredth of an inch, while different slides of the same 
blood or even in certain portions of the same slide, are uni- 
formly smaller in size than usually in the given blood. This 
contraction is likely to occur when blood absorbs moisture 
before drying. ^ Blood-disks may thus, under certain conditions, 
diminish in size; they never increase while under examination, 
above their normal diameters. The blood of man might, on 
account of contraction in diameter of the corpuscles, be con- 
founded with that of an animal having markedly smaller 
corpuscles the reverse could never take place. The diflference 
found to exist. in the average size of the corpuscles of mam- 
malian blood enables the microscopist to discriminate readily 
the blood of certain animals, including man, from that of cer- 
tain other animals of this class, especially when the higher 
powers of the instrument are employed. 

Professor Wormley concludes that the microscope may I 

enable us to determine with great certainty that a blood is not 
that of a certain animal and is coneistent with the blood of man, 
but in no instance does it, in itself, enaj>le us to say that the 
blood is really human, or indicate from what particular speci- 
mens oi animal it was derived. 

The English system of weights are retained for indicating 
the behavior of given quantities of the different poisons with 
reagents, " since this system is much more familiar to lawyers 
likely to consult the work, and were to most American physi- 
cians at present, then the metric system." 

The reputation for correctness and accuracy, which Professor 
Wormley has so justly attained, and the faithful manner in 
which these scientific attributes have been carried out in the 
original work and the revision of it, places the present produc- 
tion beyond the pale of adverse criticism. 



ONE HUNDRED YEARS OF PUBLISHING— 1785 TO 1885. 

The oldest and best known of American medical publishers, 
the house of Messrs. Lea Brothers, of Philadelphia, has reached 
the century notch in the period oi its existence. The pride is 
pardonable that is created by a retrospect that can reach back 
one hundred years, extending through the whole history of a 
great nation, from the time it was a weak, struggling colony to 
its present strength and importance. A business house which 
has survived all the changes of a century and withstood the 
fluctuations of trade, the dangers of various and untried finan- 
cial systems, with the stimulations and depressions of recurring 
war and peace, possesses qualities that a record of what they 
have accomplished is a fitting centennial memorial. 



NEW PUBLICATIONS. 271 

From this interesting narrative of the history of this busi- 
ness, we learn that Mr. Mathew Carey, the founder of the house, 
was born in Dublin in 1759. He selected the occupation of 
printer and bookseller, but the details of trade were not suffi- 
cient to satisfy his ardor and aggressive temperament. From 
the age of twenty he took an active part in the political move- 
ments of the day. Ireland soon became an unsafe place of 
residence, and he was conveyed secretly to Paris. Here he 
acquired the friendship of Benjamin Franklin and the Marquis 
de la Fayette. He returned to Ireland, was arrested, out 
escaped and embarked for the United States, and landed in 
1784 with only a few guineas in his pocket. La Fayette, who 
wa§ at the time visiting Washington at Mount Vernon, hearing 
of the arrival of young Carey, sent him four hundred dollars, 
with which he started a daily journal, the Pennsylvania Evening 
Herald. A monthly magazine, the Columbian^ was soon added 
to the Herald. The publication of books and other periodicals 
followed. The most important venture was the Bible in quarto, 
both the Douay translation and the authorized version. This 
not only required enterprise, but considerable capital for those 
early days. 

Through that ardor which characterized Mr. Carey in every 
relation of life, he established a successful business, and con- 
tinued to take an active part in the political questions of the 
day. In 1817 he associated with him his eldest son, Henry C. 
Carey, and four years later his son-in-law, Isaac Lea. By this 
time the house had already attained the position of the leading 
one in the publishing trade of the United States. All through 
his life Mr. Carey was emphatically a philanthropic and public- 
spirited citizen. From this time he devoted the remaining 
years to public interests, to benevolent enterprises, and to an 
extended system of organized private charity. 

As Carey & Lea the firm continued to prosper, as it might 
well do under the management of such ability. Mr. Henry C. 
Carey acquired a world-wide reputation for his works on polit- 
ical economy. Among scientific circles Mr. Isaac Lea's name 
has enjoyed an equally wide reputation. His contributions to 
the sciences of conchology, geology, and mineralogy have been 
exceedingly numerous and valuable. A complete bibliography 
of his scientific papers are being prepared by the Smithsonian 
Institution for early publication. After various changes the 
present firm of Lea Brothers & Co. was established at the begin- 
ning of this year. From a very early period the house gave its 
attention to the publication of medical literature. In 1820 it 
founded the Philadelphia JoumaX of the Medical and Physical 
Sciences^ which was afterwards enlarged under the name of the 
American Journal of the Medical Sciences^ of which the* late Dr. 
Isaac Hays was editor for more than fifty years, and which has 
been instrumental, perhaps more than any other single produc- 



272 NEW PUBLICATIONS. 

tion, in making American medicine known and respected 
throughout the world. The publication of the Journal brought 
the house into the most intimate relations with the leading 
minds of the profession, and nearly all the prominent medical 
writers came to be included in its list of publications. 

For a continuation of the prosperity which has continued 
for a century, the present firm relies upon a maintenance of its 
traditions of honorable dealing and unflagging industry. May 
the sounding of another century see the prosperity and useful- 
ness proportionately increased by the business house that '*has 
derived its chief gratification from the conviction that the 
extension of its business was likewise the extension of knowl- 
edge.'^ And may its imprint ever command that high respect 
that it can continue to feel *' a just pride in the belief that its 
name on a title page was in some sort an indication of the 
worthiness of the volume in which it appeared.*' 



BOOKS AND PAMPHLETS RECEIVED. 



REPORT OF PROCEEDINGS OF THE ILLINOIS STATE BOARD 
OF HEALTH. Quarterly. Meeting at Chicago, April 16 and 17, 

1885. 

RESTRICTION AND PREVENTION OF SCARLET FEVER. Docu- 
ment issued by the Michigan State Board of Health. Revised edi- 
tion, 1884. 

PROCEEDINGS OF THE FIFTH ANNUxVL MEETING OF THE 
IOWA STATE PHARMACEUTICAL ASSOC^IATION. Held in 
Marshalltown, Tuesday and Wednesday, May 27 and 28, 1884. Also 
Constitution, By-laws, Roll of Members, etc. Iowa City, Iowa. 
Republican Publishing Co., 1S84. 

FIFTY CASES OF ABDOMINAL SECTION ; WITH REMARKS ON 
LAPAROTOMY. By James B. Hunter, M. D., Surgeon to the 
Women's Hospital; Professor of Gynaecology in tiie New York 
Polyclinic, etc. Reprinted from the New York Medical Journal for 
April 4, 1885. New York: D. Appleton & Co., 1884. 

CO-OPERATION OF CITIZENS IN PREVENTING THE SPREAD 
OF DISEASE. Read at a Sanitary Convention held at East Sagi- 
naw, Michigan, December2 and 3, 1884. By Reverend W. A. Masker, 
East Saginaw. Reprinted from a supplement to the Annual Report 
of the Michigan State Board of Health for the year 1885. 

ON IDIOPATHIC ANiEMIA: A report of three cases, with Remarks 
and an Analysis of the cases hitherto published in America. By 
J. H. Musser, M. D., Chief of the Medical Dispensary, Hospital 
University of Pennsylvania; Pathologist to the Presbyterian Hos- 
pital, etc. Reprinted from the "Proceedings of the Philadelphia 
County Medical Society." Philadelphia, 1885. 

CLINICAL STUDIES ON DISEASES OF THE EYE, INCLUDING 
THOSE OF THE CONJUNCTIVA, CORNEA, SCLEROTIC, IRIS 
AND CILIARY BODY. By Dr. Ferdinand Retter von Arlt, Pro- 
fessor of Ophthalmology in Vienna. Translated by Lyman Ware, 
M. D., Surgeon to Illinois Charitable Hospital, and the Protestant 
Orphan Asylum, Chicago. 8mo : three hundred and twenty-five 
pages. Prize, 52.50. Philadelphia: P. Blakiston, Son & Co., 1885. 



f 



DISINFECTION AND DISINFECTANTS. 273 

MEDICAL DIGEST. 



DISINFECTION AND DISINFECTANTS. 



The following is the Preliminary Report of the Committee 
on Disinfectants of the American Public Health Association : 

The object of disinfection is to prevent the extension of infec- 
tious diseases by detroyihg the specific infectious material 
which gives rise to them. This is accomplished by the use of 
disinfectants. 

There can be no partial disinfection of such material; either 
its infecting power is destroyed or it is not. In the latter case 
there is a failure to disinfect. Nor can there be any disinfection 
in the absence of infectious material. 

It has been proved for several kinds of infectious material 
that its specific infecting power is due to the presence of living 
micro-organisms, known in a general way as "disease germs; 
and practical sanitation is now based upon the belief that the 
infecting agents in all kinds of infectious material are of this 
nature. Disinfection, therefore, consists essentially in the 
destruction of disease germs. 

Popularly, the term disinfection is used in a much broader 
sense. Any chemical agent which destroys or masks bad odors, 
or which arrests putrefactive decomposition is spoken of as a 
disinfectant. And in the absence of any infectious disease it is 
common to speak of disinfecting a foul cess-pool, or bad-smell- 
ing stable, or privy vault. 

This popular use of the term has led to much misapprehen- 
sion, ana the agents which have been found to destroy bad 
odors — deodorisers — or to arrest putrefactive decomposition — 
antiseptics — have b5*en confidently recommended and extensively 
used for the destruction of disease germs in the excreta of 
patients with cholera, typhoid fever, etc. 

The injurious consequences which are likely to result from 
such misapprehension and misuse of the word disinfectant will 
be appreciated when it is known that: 

necent researches have demonstrated that many of the agents 
which have been found useful as deodorisers^ or as antiseptics, are 
entirely wiihout value for the destruction of disease germs. 

This is true, for example, as regarcis the sulphate of iron or 
copperas, a salt which has been extensively used with the idea 
that it is a valuable disinfectant. As a matter of fact, sulphate 
of iron in saturated solution does not destroy the vitality of 
disease germs or the infecting power of material containing 
them. This salt is, nevertheless, a very valuable antiseptic, 
and its low price makes it one of the most available agents for 
the arrest of putrefactive decomposition in privy vaults, etc. 

Antiseptic agents also exercise a restraining influence upon the 



274 ' DISINFECTION AND DISINFECTANTS. 

development of disease germs, and their use during epidemics is to be 
recommended, when masses of organic material in the vicinity of 
human hahitations cannot be completely destroyed^ or removed, or dis- 
infected. 

While an antiseptic agent is not necessarily a disinfectant, 
all disinfectants are antiseptics; for putrefactive decomposition 
is due to the development of "germs" of the same class as that 
to which disease germs belong, and the agents which destroy 
the latter also destroy the bacteria of putrefaction, when 
brought in contact with them in sufficient quantity, or restrain 
their development when present in smaller amounts. 

A large number of the proprietary ^^ disinfectants,'*^ so called, 
which are in the market, are simply deodorisers or antiseptics, of 
greater or less value, and are entirely untrustworthy for disinfecting 
purposes. 

Antiseptics are to be used at all times when it is impracti- 
cable to remove filfth from the vicinity of human habitations, 
but they are a poor substitute for cleanliness. 

During the prevalence of epidemic diseases, such as yellow 
fever, typhoid fever and cholera, it is better to use, in privy- 
vaults, cess-pools, etc., those antiseptics which are also disin- 
fectants — that is, germicides ; and when the contents of such 
receptacles are known to be infected this becomes imperative. 

Still more important is the destruction at our sea-port quar- 
antine stations of infectious material which has its origin out- 
side of the boundaries of the United States, and the destruction, 
within our boundaries, of infectious material given off from the 
persons of those attacked with any infectious disease, whether 
imported or of indigenous origin. 

In the sick-room we have disease germs at an advantage, for we 
know where tofmd them as well as how to kill them. 

Having this knowledge, not to apply it would be criminal 
negligence, for our efforts to restrict tne extension of infectious 
diseases must depend largely upon the proper use of disinfect- 
ants in the sick room. 

GENERAL DIRECTIONS. 

Disinfection of Excreta, i^tc. — The infectious character of 
the dejections of patients suffering from cholera and from 
typhoid fever is well established ; and this is true of mild cases 
and of the earliest stages of these diseases as well as of severe 
^nd fatal cases It is probable that epidemic dysentery, tuber- 
-culosis, and perhaps diphtheria, yellow fever, scarlet fever and 
typhus fever may also be transmitted by means of the alvine 
•discharges of the sick. It is therefore of the first importance 
that these should be disinfected. In cholera, diphtheria, yel- 
low fever and scarlet fever, all vomited material should also be 
looked upon as infectious. And in tuberculosis, diphtheria, 
scarlet fever and infectious pneumonia, the sputa of the sick 
should be disinfected or destroyed by fire. It seems advisable 



) 



DISINFECTION AND DISINFECTANTS. 276 

also to treat the urine of patients sick with an infectious disease 
with one of the disinfecting solutions below recommended. 

Chloride qflime^ or bleacning powder, is, perhaps, entitled to 
the first place for disinfecting excreta, on account of the rapidity 
of its action. The following standard solution is recommended : 

Standard Solution Number One. — Di88olve cMondeoflimeofthe 
beet quality in soft water, in the proportion of four ounces to the 
gaUon, 

Use one pint of this solution for the disinfection of each dis- 
charge in cholera, typhoid fever, etc. Mix well and leave in 
vessel for at least ten minutes before throwing into privy-vault 
or water-closet. The same directions apply for the disinfection 
of vomited matters. Infected sputum should be discharged 
directly into a cup half full of the solution. 

Standard Solution Number Two. — Dissolve corrosive sublimaJte 
and permanganate of potash in soft water ^ in the proportion of two 
drachms of each scUt to the gallon. 

This is to be used for the same purposes and in the same 
way as Standard Solution Number One, It is equally efiective, but 
it is necessary to leave it for a longer time in contact with the 
material to be disinfected — at least an hour. The only advan- 
tage which this solution has over the chloride of lime solution 
consists in the fact that it is odorless, while the odor of chlorine 
in the sick room is considered by some persons objectionable. 
The cost is about the same. It must be remembered that this 
solution is highly poisonous. It is proper, also, to call atten- 
tion to the fact that it will injure lead pipes if passed through 
them in considerable quantities. 

Standard Solution Number Three.-^To one part of Labarraque^s 
solution (liquor sodm chloriruUss), add five parts of soft water. 

This solution is more expensive than the solution of chlo- 
ride of lime, and has no special advantages for the purposes 
mentioned. It may, however, be used in the same manner as 
recommended for Standard Solution Number One, 

The following powder is also recommended for the disinfec- 
tion of excreta in the ^ick room and of privy-vaults, etc. : 

Disinfecting and Antiseptic Powder, — One pound of chloride of 
Urns ; one ounce of corrosive sMimate ; nine pounds of plaster of 
Paris, Pulverize the corrosive sublim/Ue and mix thoroughly vMi 
the plaster of Paris, Then add the chloride of lime and mix well. 
Pack in paste-board boxes or in wooden casks. Keep dry. 

As an antiseptic and deodoriser this powder is to be sprinkled 
upon the surface of excreta, etc. 

To disinfect excreta in the sick room, cover the entire sur- 
face with a thin layer of the powder — one-fourth inch in 
thickness — and if the material is not liquid pour on sufficient 
water to cover it. 

Disinfection of the Person. — The surface of the body of a 
sick person, or of his attendants, when soiled with infectious 



276 DISINFECTION AND DISINFECTANTS. 

discharges, should be at once cleansed with a suitable disin- 
fecting agent. For this purpose Standard Solution Number Three 
may be used. 

In diseases like small-pox and scarlet fever, in which the 
infectious agent is given off from the entire surface of the 
body, occasional ablutions with Labarraque's solution, diluted 
witn twenty parts of water, will be more suitable than the 
stronger solution above recommended. 

In all infectious diseases the surface of the body of the 
dead should be thoroughly washed with one of the standard 
solutions above recommended, and then enveloped in a sheet 
saturated with the same. 

Disinfection of Clothing. — Boiling for half an hour will 
destroy the vitality of all known disease germs, and there is no 
better way of disinfecting clothing or bedding which can be 
washed than to put it through the ordinary operations of the 
laundry. No delay should occur, however, between the time 
of removing soiled clothing from the person or bed of the sick ^ 

and its immersion in boiling water, or in one of the following 
solutions; and no article should be permitted to leave the 
infected room until so treated. 

Standard Solution Number Four, — Dissolve corrosive suilim^ite 
in water in the proportion of four ounces to the gailon, and add one 
drachm of permanganate of potash to each gailon to give color to the 
'solution. 

One fluid ounce of this standard solution to the gallon of 
water will make a suitable solution for the disinfection of 
clothing. The articles to be disinfected must be thoroughly 
soaked with the disinfecting solution and 'left in it for at least 
two hours, after which they may be wrung out and sent to the 
wash. 

N. B. — Solutions of corrosive sublimate should not be placed in 
metal receptacles, for the salt is decomposed and the mercury 
precipitated by contact with copper, lead or tin. A wooden 
tub or earthen crock is a suitable receptacle for such solutions. 

Clothing may also be disinfected by immersion for two 
hours in a solution made by diluting Standard Solution Number 
One with nine parts of water — one gallon in ten. This solution 
is preferable for general use, especially during the prevalence 
of epidemics, on account of the possibility of acciaents from 
the poisonous nature of Standard Solution Number Four, When 
diluted as directed this solution may, however, be used with- 
out danger from poisoning through the medium of clothing 
immersed in it, or by absorption through the hands in washing. 
A poisonous dose could scarcely be swallowed by mistake, 
owing to the metallic taste of the solution, and the considerable 
quantity which would be required to produce a fatal effect — at 
least half a pint. 

Clothing and bedding which cannot be washed may be dis- 



DISINFECTION AND DISINFECTANTS. 277 

infected by exposure to dry heat in a properly constructed dis- 
infecting chamber for three or four hours. A temperature of 
230° Fahrenheit should be maintained during this time, and 
the clothing must be freely exposed, that is, not folded or 
arranged in piles or bundles, for the penetrating power of dry 
heat is very slight. 

The limitations with reference to the use of dry heat as a 
disinfectant are stated in a "Preliminary Report of the Com- 
mittee orx Disinfectants," published in the Medical News, Phila- 
delphia, March 14, 1885. 

The temperature above mentioned will not destroy the 
spores of bacilli — for example, of the anthrax bacillus, out is 
effective for the destruction of all disease germs which do not 
form spores: and there is good reason to believe that this list 
includes small-pox, cholera, yellow fever, diphtheria, ervsipelas, 
puerperal fever, and scarlet fever (?) Moist heat is lar more 
effective, and it is demonstrated that ten minutes exposure to 
steam, at a temperature of 230° Fahrenheit, will destroy all 
known disease germs, including the most refractory spores. 

In the absence of a suitable disinfecting chamber, it will be 
necessary to burn infected clothing and bedding, the value of 
which would be destroyed by immersion in boiling water, or 
in one of the disinfecting solutions recommended. 

Disinfection of the Sick Room. — In the sick room no dis- 
infectant can take the place of free ventilation and cleanliness. 
It is an axiom in sanitary science that it is impracticable to dis- 
infect an occupied apartment; for the reason that disease germs 
are not destroyed by the presence in the atmosphere of any 
known disinfectant in respirable quantity. Bad odors may be 
neutralized, but this does not constitute disinfection in the 
sense in which the term is here used. These bad odors are, for 
the moat part, an indication of want of cleanliness, or of proper 
ventilation : and it is better to turn contaminated air out of the 
window, or up the chimney, than to attempt to purify it by the 
use of volatile chemical agents, such as carbolic acid, chlorine, 
etc., which are all more or less offensive to the sick, and are 
useless so far as disinfection — properly so-called — is concerned. 

When an apartment which has been occupied by a person sick 
unih an infectious disease is va^caJted, it should be disinfected. But 
it is hardly worth while to attempt to disinfect the atmosphere 
of such an apartment, for this will escape through an open win- 
dow and be replaced by fresh air from without, while prepara- 
tions are being made to disinfect it. Moreover, experience 
shows that the infecting power of such an atmosphere is 
quickly lost by dilution, or by the destruction of floating dis- 
ease germs through contact with oxygen, and that even small- 
pox, and scarlet lever are not transmitted to any great distance 
through the atmosphere; while cholera, typhoid fever, and 
yellow fever, are rarely, if ever, contracted by contact with the 



278 DISINFECTION AND DISINFECTANTS. 

sick, or by respiring the atmosphere of the apartments occupied 
by them. 

The object of disinfection in the sick room is, mainly, the 
destruction of infectious material attached to surfaces, or depos- 
ited as dust upon window-ledges, in crevices, etc. If the room 
has been properly cleansed and ventilated while still occupied 
by the sick person, and especially if it was stripped of carpets 
and unnecedsary furniture at the outset of his attack, the diffi- 
culties of disinfection will be greatly reduced. 

All surfaces should be thoroughly washed with a solution 
of corrosive sublimate of the strength of one part in one thou- 
sand parts of water, which may be conveniently made by 
adding four ounces of Standard SoliUion Number Four to the 
gallon, or one pint to four gallons of water. The walls and 
ceiling, if plastered, should be brushed over with this solution, 
after which they may be whitewashed with a lime wash. 
Especial care must be taken to wash away all dust from win- 
dow-ledges and other places where it may have settled, and to 
thoroughly cleanse crevices and out-of-the-way places. After 
this application of the disinfecting solution, and an interval of 
twenty-four hours or longer for free ventilation, the floors and 
wood-work should be wen scrubbed with soap and hot water, 
and this should be followed by a second more prolonged expos- 
ure to fresh air, admitted through open doors and windows. 

Many sanitary authorities consider it necessary to insist 
upon fumigation with sulphurous acid gas — produced by com- 
bustion of sulphur— for tne disinfection of the sick room. As 
an additional precaution this is to be recommended, especially 
for rooms which have been occupied by patients with smali- 

fox, scarlet fever, diphtheria, typhus fever and yellow fever, 
t should precede the washing of surfaces and free ventilation 
above recommended. But fumigation with sulphurous acid 
gas alone, as commonly practiced, cannot be relied upon for the 
disinfection of the sick room and its contents, including bed- 
ding, furniture, infected clothing, etc., as is popularly believed. 
And a misplaced confidence in this mode of disinfection is 
likely to lead to a neglect of the more important measures 
which have been recommended. In the absence of moisture 
the disinfecting power of sulphurous acid gas is very limited, 
and under no circumstances can it be relied upon for the 
destruction of spores. But exposure to this agent in sufficient 
quantity, and for a considerable time, especially in the presence 
of moisture, is destructive of disease germs, in the absence of 
spores. It is essential, however, that the germs to be destroyed 
shall be very freely exposed to the disinfecting agent, which 
luis but slight penetrating power. 

To secure any remUs of value it wiU be necessary to close the 
apartment to be disinfected as completely as possible by stopping all 
apertures through which the gas might escape^ and to bum not less 



DISINFECTION AND DISINFECTANTS. 279 

than three pounds of sulphur for each thousand cubic feet of air- 
space in the room. To secure complete combustion of the sulphur 
it should be placed, in powder or in small fragments, in a 
shallow iron pan, which should be set upon a couple of bricks 
in a tub partly filled with water, to guard against fire. The 
sulphur should be thoroughly moistened with alcohol before 
igniting it. 

Disinfection of Privy-Vaults, Cess-Pools, etc. — When the 
excreta — not previously, disinfected— of patients with cholera 
or typhoid fever, have been thrown into a privy-vault this is 
infected, and disinfection should be resorted to as soon as the 
fact is discovered, or whenever there is reasonable suspicion 
that such is the case. It will be advisable to take the same 
precautions with reference to privy-vaults into which the 
excreta of yellow fever patients have been thrown, although we 
do not definitely know that this is infectious material. Disin- 
fection may be accomplished either with corrosive sublimate or 
with chloride of lime. The amount used must be proportioned 
to the amount of material to be disinfected. 

Use one pound of corrosive sublimate for every five hundred 
pounds — estimated — of fecal matter contained in the vaults or one 
pound of chloride of lime to every thirty pounds. 

Standard Solution Number Four^ diluted with three parts of 
water may be used. It should be applied — the diluted solu- 
tion — in the proportion of one gallon to every four gallons — 
estimated — of the contents of the vault. 

If chloride of lime is to be used, one gallon of Standard 
Solution Number One will be required for every gallon — estimated 
— of the material to be disinfected. 

All exposed portions of the vault, and the wood- work above 
it, should be thoroughly washed down with the disinfecting 
solution. 

To keep a privy- vault disinfected during the progress of an 
epidemic, sprinkle chloride of lime freely over the surface of 
its contents daily. Or, if the odor of chlorine is objectionable, 
apply daily four or five gallons of Standard Solution Number 
Two, which should be made up by the barrel, and kept in a 
convenient location, for this purpose. 

Disinfection of Ingesta — It is well established that cholera 
and typhoid fever, are very frequently, and perhaps usually, 
transmitted through the medium of infected water or articles 
of food, .and especially milk. Fortunately we have a simple 
means at hand for disinfecting such infected fluids. This con- 
sists in the application of heat. The boiling temperature main- 
tained for half an hour hills all known disease germs, 80 far as the 
germs of cholera, yellow fever, and diphtheria are concerned, 
there is good reason to believe that a temperature considerably 
below the boiling point of water will destroy them. But in 
order to keep on the safe side it is best not to trust anything 



280 SALICYUC PAPER. 

short of the boiling point (212° Fahrenheit) when the object in 
view is to disinfect food or drink which is open to the suspi- 
cion of containing the germs of any infectious disease. 

During the prevalence of an epidemic of cholera it is well 
to boil all water for drinking purposes. After boiling, the 
water may be filtered, if necessary to remove sediment, and 
then cooled with pure ice if desired. 

A sheet of filtering paper such as druggists use, and a glass 
or tin funnel, furnishes the best means for filtering water on a 
small scale for drinking purposes. A fresh sheet of paper is to 
be used each day. 

SALICYLIC PAPER. 



Any white absorbent paper is suitable for the purpose, but 
the particular kind to be used must depend somewhat on the 
special object for which it is intended. Thus, for covering 
honey, preserves, milk, cream, or similar articles, ordinary ^ 

English white filter — or blotting— paper answers well ; but for * 

butter, fresh meat in small pieces, or delicate fruit and vege- 
tables, a less " tender " paper should be selected ; whilst, if 
required for wrapping up large joints of meat and the coarser 
fruits, etc., a still more substantial material must be chosen, 
such, for instance, as a stout, unpressed, *' printing " or soft 
white ''sugar paper." It is almost essential that the paper 
employed should be unglazed or practically without sizing of 
any kind. 

Any convenient quantity of salicylic acid is taken and 
•divided into two ecjuai parts ; one of these is then dissolved in 
the following solution previously warmed : 

Sulphate of sodium 30 grains. 

iUborate of sodium (borax) 50 grains. 

Water 1 fluid ounce. 

The solution should be poured hot upon the acid with con- 
stant stirring, not much more of the liquid being used than is 
needed to effect a complete solution. 

The other half of the acid is meanwhile to be digested in a 
little warm glycerine diluted to the density of about one one- 
hundredth or one one-hundred-and-fiftieth, one-third more 
glycerine than has been found requisite to effect the solution of 
the acid being subsequently added. Both solutions may then 
be mixed together, water being cautiously added, until the 
strength is equal to from three per cent of salicylic acid for the 
thicker, to five per cent for the thinner papers. Should any 
crystalization or precipitation of the acid occur, glycerine must 
be added by degrees until it is again taken up and the liquid 
becomes perfectly clear. 

The papers to be impregnated should be immersed one by 
one in a large shallow dish or pan about two-thirds tilled with 



IDIOPATHIC ANEMIA OF ADDISON. 281 

the Bolation, somewhat in the same way that paper is '^ salted " 
for photographic purposes. If the solution he used rather 
warm, say about 140° or 150° Fahrenheit, four or five minutes' 
soaking will be sufficient; but for the thickest and least per- 
vious paper a somewhat longer period is advisable, if the 
liquid oe used cold, fifteen or twenty minutes is not too much 
time to allow for maceration before taking out the sheets, drain- 
ing them, and hanging them up to drv, which latter operation 
is preferably completed in the sunshine, before a fire, or in a 
cool oven. 

These salicylic papers may be kept in a cool, dry place, 
pressed flat between the leaves of a book or portfolioj or rolled 
up tightly for any length of time without deterioration, or loss 
of preservative strength. 

A large number of articles of food and drink and of animal 
and vegetable substances, ordinarily liable to fermentive or 
putrefactive change, may be prevented from decomposing for 
some time by the judicious use of salicvlic paper, which we 
have known to keep free from "mould" for several 'months 
some badly-prepared extract of taraxacum, which without it 
invariably showed symptoms of the development of PeniciUium 
within a few days. — British and Colonial Druggist 



IDIOPATHIC ANiEMIA OF ADDISON. 



This disease, more generally known by the name of pro- 
gressive pernicious anaemia, applied to ifr by Biermer in 1871, 
was first described in 1855 by Addison, in his famous treatise 
"On the Constitutional and Local Effects of Disease of the 
Suprarenal Capsules." It was while engaged in the study of 
this form of anaemia that Addison, to use his own words, 
^stumbled upon " the discovery of the affection termed by him 
melasma suprarenale, with which his name will be ever asso- 
ciated. It was the fortunate lot of Addison to stumble upon 
" no less than four morbid conditions before unrecognized or 
imperfectly described : xanthelasma, described by himself and 
Dr. Gull under the name vitiligoidea ; keloid, or morphoBa, 
which, as Dr. Fagge has shown, is allied to or identical with 
scleroderma; idiopathic anaemia; and melasma suprarenale." 

Before the publication of Addison's treatise several isolated 
cases of this fatal form of anaemia were reported, of which the 
earliest, as shown by Dr. Pye-Smith, is probably that of Drs. 
Combe and Kellie, which appeared in the *' Transactions of the 
Medico-Chirurgical Society of Edinburgh for 1823." 

The disease differs from most others in being absolutely 
devoid of lesions except such as are secondary to the altered 
condition of the blood. Among these the most prominent are 
fatty degeneration of the heart, livef, glandular epithelium, 
especially of the gastric tubules and of tne intima of the arte- 



282 IDIOPATHIC AN.CMIA OF ADDISON. 

ries, haemorrhages in the retina (first described by Biermer) as 
well as in the corona radiata and on the cerebral surface, some- 
times in the form of a hsemorrhagic pachymeningitis. In genu- 
ine cases of idiopathic anaemia the organs universally recog- 
nized as haematopoietic — namely, the lympharia, spleen, and 
bone-marrow — ^are unaltered. It follows, therefore, either that 
there are cytogenic organs of the very existence of which we' 
are ignorant, or that in idiopathic anaemia there is an abnormal 
destruction of red corpuscles. Certain facts favor the latter 
view. Among them are the deep color of the urine often 
observed when the red corpuscles are markedly deficient in 
number, the dark-red color of the muscles, the dark hue of 
liver, spleen, kidneys, and pancreas, and the unusually yellow 
color of the subcutaneous fat. 

The red corpuscles are often greatly increased in size, vary- 
ing from four to eleven or even fifteen micro-millimetres, the 
average in health being eight and a half. " Those of large size 
were much more numerous than the smaller, and, in conse- 
quence, the blood in this disease presents a remarkable and 
characteristic peculiarity — namely, that the reduction in the 
number of the corpuscles is greater than that in the quantity 
of hsemoglobin ; so that the value of the corpuscles is greater 
than normal. In this respect it differs from all other forms of 
ansemia, since in these the value of the corpuscles either is 
unaltered or is below normal." 

Unfortunately for diagnostic purposes, this increased size of 
the red corpuscles 'is not constant in idiopathic anaemia; 
neither is the presence of microcytes, minute red corpuscles, 
nor altered shape of the red corpuscles, poikilocytosis. The 
writer has observed both of these peculiarities in a case of 
anaemia splenica. 

If, in a case of anaemia, a count of the red corpuscles shows 
their number to be below one million per cubic millimetre, 
and the white not absolutely increased, and there is no disease 
of any tissue or organ of the body, the case is probably one of 
idiopathic anaemia. If, in addition, many of the red corpus- 
cles are enlarged to such an extent that the average value in 
haemoglobin of each, as tested by the haemochromometer, is as 
great as or greater than normal, the diagnosis is certain. 

The etiology of idiopathic anaemia is quite as obscure as its 
pathology. The influence of depressing emotion appears, 
huwever, to be manifest, especially when it is sudden ana vio- 
lent. This was first pointed out by Wilks, and was illustrated 
by some remarkable cases reported by Dr. R. G. Curtin at a 
recent meeting of the Philadelphia County Medical Society. 
Exception may be taken to Dr. Curtin's cases because in none 
of them was there an examination of the blood or a necropsy, 
but clinically they present every evidence of being genuine 
cases of idiopathic anaemia. 



DIPHTHERIA AND SCARLET FEVER. 288 

Since arsenic was used in the treatment of this disease by 
Dr. Byrom Bramwell, the term pernicious has become less 
appropriate than when first employed by Biermer. A number 
01 recoveries have been reported in which* this remedy was 
exhibited at a late stage of the disorder. Iron, the main stay 
in the treatment of chlorosis, is of little or no benefit in idio- 
pathic ansemia, and their different behavior towards this rem- 
edy constitutes the principal distinguishing mark between the 
two diseases, which in all other respects are remarkably simi- 
lar. — Philadelphia Medical Times, 



THE ALBUMINURIA OF DIPHTHERIA AND SCARLET FEVER. 



It is well known that albuminuria is a very common compli- 
cation of both diphtheria and scarlet fever ; that it is as frequent 
and probably more so, in the former than the latter. Few, 
however, have paused to consider whether there is any differ- 
ence in the immediate conditions which cause it. That the 
albuminuria of scarlatina is the result of a nephritis is gener- 
ally understood, and we incline to believe that most physicians 
would ascribe the albuminuria of diphtheria to the same cause. 
At the same time no very close examination is necessary in 
order to reveal important aifferences in their conditions. How 
rare, for example, is it to find ursemia or renal dropsy in diph- 
theria? 

Senator has called attention to the difference in some 
remarks recently made before the Berlin Medical Society, and 
published in the Berliner Klin, Wochenshrifty December 1, 1884. ^ 
According to him the albuminuria of diphtheria is an albumi- 
nuria of congestion, altogether unassociated with the phenom- 
ena of inflammation, unless the congestion continue a very long 
time, when we may have superadded what is known as conges- 
tion-nephritis, or cyanotic induration. The congestion may be 
brought about in two ways: first, by an extension of the diph- 
theritic process to the larynx, the consequent dyspnoea produc- 
ing a general engorgement which the kidneys share with the 
rest of the body ; or, it may occur later in the disease, from 
paralysis of the vagus and feebleness of the heart. Such con- 
gestion is not infrequently associated with oedema of the lower 
extremities, which is also favored by the ansemia, which is by 
this time present. An albuminuria from such causes seldom 
occurs in scarlet fever. 

Another form, associated with diphtheria, may be called 
infectious — febrile albuminuria. This occurs, frequently, early 
in the disease, or when the throat affection is at its height and 
is unaccompanied by any other symptoms of nephritis, such 
as blood, leucocytes, or epithelium in the urine. Sometimes, 
indeed, hyaline tube-casts are present, but these do not indi- 
cate inflammation. This albuminuria is comparable to that 



284 THE TREATMENT OF HAY FEVER. 

associated with the acme of other ferine processes, disappearing 
with the subsidence of the ferine. After death no changes are 
found in the kidney, or they are confined to limited areas of 
cloudy swelling of the epithelium, such as is often found with 
albuminuria. 

There is, indeed, a third form of albuminuria in diphthe- 
ria, which is neither congestive nor febrile-infectious, but which 
is due to a mild nephritis differing from the majority of cases 
of scarlatinal nephritis in its slighter anatomical cnanges, as 
well as in the mildness of its clinical features. In it, interstitial 
and vascular changes, as well sa* changes in the malpighian 
capsules, are much less marked than in scarlatinal nephritis ; 
and although it is true that higher degress of nephritis, with 
their characteristic clinical phenomena, are sometimes present, 
their great rarity. must be admitted. 

It should be stated, however, that Henoch, to the reading of 
whose paper on diphtheria succeeded the remarks of Senator, 
to which we have called attention, is inclined to believe that - 

the diphtheritic albuminuria ascribable to asphyctic congestion, } 

is the rarest form ; that the cases in which albuminuria is pres- 
ent are often unattended by fever of any severity. He claims 
that the albuminuria of diphtheria is almost always the result 
of infection, and is to be included in the extensive group of 
infectious nephritis, notwithstanding the fact that Weigart and 
Purbringer have failed to discover bacteria in the kidney undSr 
these circumstances. 

There has always seemed to be a marked difference between 
the albuminuria of most cases of diphtheria and scarlet fever, 
and Senator has already indicated these differencea as they 
have often presented themselves. — Medical News, April 11, 1886. 



THE TREATMENT OF HAY FEVER. 



Lennox Browne (British Medical Journal) disapproves of the 
use of insufflations in the treatment of this disease, as being 
unscientific in theory as well as in application. He has long 
employed ointments, his own favorite formula being a drachm 
of oil of eucalyptus to an ounce of vaseline. This is carefully 
applied to the mucous membrane of the nose by means of a 
camel's-hair brush. As a radical measure he recommends the 
cauterization of the mucous membrane by means of the gal- 
vanic cautery at a dull red heat, or by the use of nitric, acetic, 
or chromic acid. Local causes of irritation, such as relaxed 
uvula, polypi, or hypertrophic rhinitis, should always be sought 
for ana removed. As regards internal remedies, the writer 
places a good deal of confidence in opium and belladonna, stat- 
ing that these drugs, when combinea, not only prevent the un- 
pleasant physiological effects which follow the use of either 
when administered alone, but also exert a more marked influ 



HAY FEVER — MISCELLANEOUS ITEMS. 285 

ence over the disease. "I venture," he concludes, "to differ 
from the dictum that the treatment of hay fever need by any 
means be considered as unsatisfactory, provided only it be con- 
ducted on scientific, not on empirical grounds." — New York Med- 
ical Joumcd. 



HAY FEVER. 



William S. Paget {British Mediccd Journal) offers some sug- 
gestions with regard to this affection, from which he is himself 
a sufferer. He finds from his own experience that the active 
agent in causing the peculiar symptoms is not confined to the 
pollen of the Graminaceas^ since the perfume of any flower in 
full bloom will produce a similar effect after the disease has 
been once established. During an intense heat and when an 
east wind is blowing, he finds that the attacks are especially 
aggravated. A bright light also increases, though it does not 
produce, the symptoms. The writer has little faith in internal 
treatment ; as regards local measures, he insists upon the neces- 
sity of protecting the eyes against pollen, dust, and also the 
glare of the sun. Veils and goggles are recommended for this 
purpose. He has experienced great relief from the use of tepid 
collyria of water, or a solution of zinc, morphine, and hydro- 
cyanic acid ; cold applications should be avoided, since their 
after-effects are unpleasant. Nasal irritation may be relieved 
by the inhalation of a mixture of equal parts of liquor ammo- 
ni8e and carbolic acid. — New York Medical JoumcU, 



MISCELLANEOUS ITEMS. 



The daily application of phosphoreted oil (one part to three 
hundred) is recommended as a radical cure for corns. 



An Urethral Ointment for Gonorrhcea. — In the Deutsche 
Medizinal Zeitung, Unna recommends the frequent introduction 
of a sound smeared with the following : 

B. Nitrate of silver gr. xxx. 

Peruvian balsam gr. Ix. 

Tellow wax jj. to ij. 

Cocoa butter gvj. 

A LAW regulating the administration of anaesthetics is in 
the State of Onio, as follows: " Whoever uses upon another an 
ansesthetic, unless at its administration, and during the whole 
time, the person is wholl}^ or partly under the direct influence 
of it, there is present a third person competent to be a witness, 
shall be finea not more than twenty-five nor less than five 
dollars." This law was passed and went into effect April 3, 
1876. — New England Medical Monthly. 



286 MISCELLANEOUS ITEMS. 

Radical Cure of Hernia. — Mr. Lawson Tait describes, in 
the British Medical Journal^ his method for the radical cure of 
umbilical hernia by abdominal section, and considers it appli- 
cable to other forms of hernia. He opens the sac, frees all 
adhesions, cuts off omentum that may be in the way, pares the 
edges of the ring, and stitches up the wound with a continuous 
silk thread, which he leaves permanently. The results have 
been most satisfactory. — Ainerican Practitioner, 

Physiological Action of Cocaine. — Brown-Sequard, in a 
recent communication to the Societe de Biologic, stated that in 
his investigation into the action of cocaine he had been able to 
demonstrate experimentally that this substance did not act 
locally in producing anaesthesia, but, on the contrary, by inhi- 
bition from a distance. M. Charpentier announced that cocaine 
is a powerful poison — more active than strychnine or atropine 
— upon infu8or\A and chlorophyll. — Le Progres Medical, 

HiEMOSTATic PiLi^. — In the following formula of Huchard 

the ergotine and quinine produce contraction of the vessels, the 

digitalis controls the circulation, and the hyoscyamis allays the 

nervous excitement: 

R. Ext. ergot®, 

Quininae sulphatis aa ^ss. 

Pulv. digitahs, 

Ext. hyoscyamia aa gr. iij. 

M. Divide in pilalas number twenty. S. Take five to eight daily. 

Biliary Calculi. — Huchard uses the following combina- 
tion in the treatment of gall-stones : 

R. Res. podophylli, ] 

Ext. nyoscyami, > aa gr.v. 

Saponis, j 

Make ten pills, of which one or two may be taken daily. 

The addition of a small amount of Rhubarb, or, if constipation 

requires it, of aloes, makes the above a useful formulse for a 

cholagogue cathartic. — Revue de Ther. Med. Chir. 

Practical Therapeutics. — Vomiting of Premancy^^iyr, T. T. 
Gaunt, has employed compound tincture of iodine in drop 
doses with much success. PrurittLS — Dr. Thackeray treats the 
pruritus formicans of pregnancy with cider vinegar as a local 
application and has never failed to effect a cure. Strangury — 
For the excessive strangury which frequently occurs m the 
early months of pregnancy, either of the following will afford 
relief: Creosote, twelve drops; vinegar, twelve drops j cinna- 
mon water, three ounces. Mix. Dose — A teaspoonful m water 
every hour until relieved; or, bicarbonate of potash, one 
drachm; water, one to two pints. Mix. Dose— Tablespoonful 
every two hours. — Saint Louis Medical Journal. 



I 



MISCELLANEOUS ITEMS. 287 

An Ointment for Sycosis. — Hebra proposes the following 
formula ( Wiener Med, Blatter) which is a modification of one 
proposed by Wilkinson : 

*• Krdde"^"'""} -3viij. 

|°J'«'*P'} aa^y. 

Prepared chalk 3v. 

After the hair over the diseased spot has been cut short, and 
the crusts have been taken away, rub in the ointment thor- 
oughly and apply a flannel bandage. The ointment should be 
applied daily, the affected hairs being carefully pulled out and 
the pustules emptied. The cure is said to be complete in about 
ten days. 

Dr. Dumars, of Peoria, reports the case of a man about 
forty-five years of age, the janitor of the building in which his 
office is located, who had been a sufferer from rheumatism for 
nearly ten years. The attacks were very frequent and very 
severe, often necessitating the use of crutches, and would not 
yield to treatment with any degree of certainty. During the 
paroxysms relief from pain was secured only by the use of 
morphine. Having received a sample bottle of Tongaline he 
gave it to this patient, who derived so much benefit from the 
use of its contents that he took the remedy regularly. Having 
used three bottles within four weeks he found himself entirely 
free from the complaint and has experienced no recurrence 
since, although eighteen months have past, and he has been 
able to attend to all of his duties during two very severe winters. 

Acute Abscesses. — Professor S. W. Gross says it is a mistake 
to apply a poultice to an acute abscess after its contents have 
been evacuated. The endeavor should be tcT prevent, and not 
to encourage, the further formation of pus. To do this the 
cavity of the al^scess should be syringed out with a one to one 
thousand solution of mercuric bichloride, and the walls brougnt 
together by compressure and a bandage, and union allowed to 
take place by granulation. If the abscess be of large size a 
drainage tube should be left in for a couple of days until the 
serous oozing has been reduced to a minimum. The tube 
should then be taken out and the walls brought close together. 
If the healing process be delayed by the development of flabby 
oedematous granulations they can be stimulated to healthy 
action by carbolic acid or the application of three grains of 
chloride of zinc and one ounce of aqua. 

Anglo-Swiss Milk Food. — We beg leave to call the atten- 
tion of physicians and mothers to the advertisement oif the 
Anglo-Swiss Milk Food for infants, prepared by the Anglo- 



288 MISCELLANEOUS ITEMS. 

Swiss Condensed Milk Company in Cham, Switzerland, and 
sold in this country by Messrs. Thurber & Co. The proper 
feeding of infants is a subject that has always taxed the skill 
and knowledge of professional men, and experience has at last 
shown that condensed milk is more extensively ased at pres- 
ent, with happy results, than any other substitute for mother's 
milk. Care must, however, be taken in using condensed milk, 
as there is danger of children suffering from food too rich and 
nutritive for proper digestion as well as from receiving too little 
nourishment. The Anglo-Swiss Milk Food is intended to take 
the place of condensed milk, whenever the use of it has been 
partially or fully discontinued, say from the age of four months. 
The superiority claimed for this food over any other farinaceous 
food is that the former is so prepared that when gradually 
heated with water, according to the directions for use, the 
starch contained in the materials used, and which in its indi- 
vidual character is highly detrimental to digestion, is converted 
in a satisfactory degree into soluble and easily-digestible dex- 
trine and sugar. The company do not claim that the starch in 
this food is wholly converted, but that the comparatively small 
portion remaining has been so deprived of its individual type 
as to render it impossible to form a paste from the Food by 
heating it with water. The analysis of the Anglo-Swiss Milk 
Food contains five to six per cent of moisture, fourteen to fif- 
teen of nitrogenous matter, fifty-four to fifty-five of carbo- 
hydrates soluble in water, fifteen to sixteen of carbo-hydrates 
insoluble in water, five to six of fat, and two to two and one- 
fifth of ash. 



Pills for Spermatorrhoea. — In the Union Medicate, Dr. 
Sinety proposes the following pill : 

Bt. Extract of belladonna, 

Powdered belladonna root aa gr. iij. 

Confection of rose q. s. 

Divide into ten- pills. One to three pills should be taken 
before going to bed. According to the same writer the follow- 
ing pill is also efficacious : 

B. Camphor gr. j. 

Lupulin gr. ij. 

This treatment is specially adapted to seminal emissions 
resulting from spasm of the seminal vesicles; if, however, the 
spermg,torrhcea is due to atony of the parts, the author prefers 
to give this mixture : 

R. Powdered ergot gr. vj. 

Powdered nux vomica gr. j* 

Divide into three pills. One to be taken morning and 
evening before eating. Cold douches and applications of cam- 
phor liniment to the small of the back are to be employed at 
the same time. — Yew York Medical Journal, 



THE 



PHYSICIAI AKD SURGEON 

A MONTHLY MAGAZINE. 
DEVOTED TO MEDICAL AND SURGICAL SCIENCE. 



Volume VII. JULY, 1885. Number VIL 



ORIGINAL ARTICLES. 



DUTY OF THE STATE TOWARDS THE MEDICAL PROFESSION.* 



BY CONRAD QBORGE, M. D., ANN ARBOR. MlcmOAM. 



As a portion of the press of our state, the moulder and direc- 
tor of public opinion, and meml>ers of the medical profession 
have used every opportunity during the last ten years, not to 
question, but to condemn the right of the state to teach medi- 
cine, it seems both proper and opportune that on an occasion 
like this a word should be spoken in defense of the very exist- 
ence of our alma mater. These attacks have been sustained 
with such persistency, and ingenious force of argument, that 
many have come to regard the statement, that under our forms 
of government, the state has no right to teach medicine, as a 
pohtical axiom, and its practical adoption as simply a question 
of time. It therefore suffices no longer to meet them with the 
confident assertion that the existence of this school is assured 
by the organic law of the state, for constitutions are only safe 
as long as they are in accord with the progressive thought of 
the majority of the commonwealth ; these attacks must be met 
and conquered in the arena of thought, if our alma mater is to 
continue undisturbed in her hitherto bright career of honest 
work for the good of the people, and the advancement of med- 
ical science. 

It would lead beyond the scope of this paper to attempt an 

* Address of the President of thf) Medical Alumni Association of 
the University of Michigan, June 24, 1885. 



290 DUTY OF STATE TOWARDS MEDICAL PROFESSION. 

exhaustive refutation of all the arguments advanced in favor of 
this non-interference doctrine of the state in medical education, 
as based on the ground of being foreign and detrimental to the 
spirit and tendencies of our democratic forms of government. 
As much of the argument partakes strongly of that sentimental 
style of reasoning, so common in the United States, which 
regards every new departure as an infringement of the liberties 
guaranteed by the constitution, it may not be out of place to 
meet this argument in a general way, by tracing the nistoric 
growths of constitutions and statute laws. 

The constitutional law, as well as the statute laws of a 
state or government, will always reflect the garnered wisdom of 
the people, gathered from the experience of the ages, and culled 
from every source. In the centuries of the historic past, his- 
tory records this prominent fact of the generations and empires 
as they succeeded one another in the upward strides of civili- 
zation, that the successor generally adopted those laws and 
regulations of the predecessor, which had been found most 
expedient in regulating the varied relations of the subject and 
his vocation towards the state, and the community, modifying 
and improving as occasion demanded. Without this predom- 
inent tendency of immitation, adaptation, and subsequent 
improvement of government, the upward strides of our civili- 
zation would indeed have been less frequent and of inferior 
dimensions. 

It is a well established truth that the law must keep abreast 
with those varied complexions of relations resulting from 
increase of population, and accumulation of wealth, if the 
state is to continue to protect the citizen in the possession of 
those rights and privileges, for the very maintainance of which 
the state herself was inaugurated. A state which regards her 
constitution and statute laws as complete and unalterable can- 
not in the course of time protect her citizen in the possession 
of those very rights which she guarantees, for new dangers, 
incident to, and inseparable from the battle of life, as popula- 
tion increases, are constantly assuming gigantic proportions if 
unrecognized by law. 

When our government was established the population was 
small, and the extent of country vast and unexplored. A for- 
eign ruler has been cast aside on account of his oppressions, 
and the people felt that buoyant confidence of youth in man- 
aging their institutions according to their needs, without the 
interference of government That, under these circumstances 
the regulation of the varied internal relations of the people in 
their avocations was left to the unconscious growth of human 
necessity, is obvious. The citizen was anxiously jealous of his 
personal liberties, and would jealously oppose any measure 
which presented any conceivable ground of alarm for those 
principles for which he had so freely offered his life-blood on 



DUTY OF STATE TOWARDS MEDICAL PROFESSION. 291 

many a hard fought field. It is an historical fact, that Alexan- 
der Hamilton met great organized opposition in Pennsylvania, 
when he attempted to raise the first federal revenue by impos- 
ing and collecting a tax on the distillation of spirits. In those 
days the general government, as well as the state legislatures 
had but little control in the regulation of internal affairs; — the 
function of government was chiefly restricted towards protect- 
ing the life and liberty of the subject from foreign foes. 

Times have changed since then. The general government 
has naturally, and rightfully, assumed sovereign control over 
the states, and the states, in turn, have assumed supreme con- 
trol in regulating by statute law nearly every industrial voca- 
tion, which has grown beyond local demands. 

Had Patrick Henry, with all his burning eloquence, fore- 
shadowed such consequences in the continental congress, when 
the representatives of the states, in constitutional convention, 
were shaping and framing our constitution, it is extremely 
doubtful if this government would have come into existence'! 
And yet all these vast changes have been wrought without 
infringing the liberty guaranteed by that constitution. The 
liberty of the subject has not been infringed, but his protection 
ever widened by these gradual restrictions of previously uncon- 
trolled vocations. 

These laws in their aggregate represent no more and no less 
than the applied wisdom of our age. They are the pruning 
process of our time on the tree of civilization, destroving the 
rank growths, and directing those sprouts potent with future 
harvests in proper direction, in short, they represent the high- 
water mark of our generation in the upward strides of civilization. 

That, but little has hitherto been done towaiUs regulating 
by law the practice of medicine and surgery, must be ascribed 
to that so generally prevalent idea, that all such medicinal laws 
are potent with dangers to the citizen, the result, perchance, of 
a general misunderstanding of the true relation of the physi- 
cian and surgeon to the general public. Present indications, 
however, render ample assurance that the public is fast becom- 
ing reconciled to a new departure in medical affairs. 

The medical bill, at present under consideration by our 1^- 
islature, is a wise step in the right direction ; so far this bill has 
been endorsed by the profession, and the press has rendered 
quiet consent. May its safe delivery be accomplished. 

With these preliminary considerations, which have a gen- 
eral bearing on the subject under consideration established : I 
propose to meet the press, and a hostile portion of the proies- 
sion, on their lines of attack on this department of the univer- 
sity, namely, that it represents an act of class favoritism, and it 
is detrimental to the best interests of the medical profession, 
and so detrimental to the general good. 

When admitting the doctrine tnat under our forms of gov- 



292 DUTY OP STATE TOWARDS MEDICAL PROFESSION. 

eminent, the general government, as well as the individual 
states have no right to bestow a pecuniarv favor without 
receiving full value in return on any individual, industiy, or 
commercial or professional institute, I am, to the best of my 
knowledge, admitting all that can possible be declared as class 
favoritism, as wrong m principle, and detrimental to the spirit 
of our institutions. 

Standing on this admitted ground, the press charges that 
the state is here bestowing a pecuniary consideration on indi- 
viduals without receiving value in return, for the doctor is paid 
for his services, and that the state could with equal right engage 
in teaching all trades, industries, etc. 

On considering the relation of all the manifold industries, 
trades, etc., to the eeneral public, the following factor comes 
into bold relief. The government by granting a patent on all 
new inventions, and improvements, stimulates the inventive 
genius towards exerting his full strength, and protects him in 
his natural rights. By the rights and privileges of this patent, 
the inventor and his profession receive full value for all the 
advantages oflFered to the public for every invention and 
improvement. The vast sums which have flown into the coflfers 
of inventors of generally employed articles of usefulness or 
necessity, render most assuredly, ample evidence that all possi- 
ble claims are paid, and therefore, I cannot possibly conceive 
the right of any industry, trade, or profession, which is pro- 
tected by patent in its inventions, ana improvements, to claim 
any further assistance or protection from government Prom 
the time that the apprentice enters his master's workshop he 
receives full pecuniary remuneration for his labor; he is paid 
for learning a profession in which every step of progress means 
revenue increased. 

That the patent is amply sufficient to stimulate and enlist 
the inventive ^nius is demonstrated in every sphere of activity. 
Compare any industry of to-day with its predecessor of even 
twenty years, and you behold the grand march of thought in 
its every sphere of activity. 

The great difference which exibts between the relation of 
the medical profession to the general public, and that of all 
other professions, trades, industries, etc., is so generally over- 
looked, that it is at the risk of seeming arrogant that one can 
call attention thereto. 

The practitioner enters the home and the workshop of man 
to study, and remove, if possible, the local causes of disease. 
The trained investigators of the profession are constantly 
engaged in prosecuting the difficult and often dangerous work 
of investigating the causes of infectious and contagious disease, 
and its mode of spreading. This vast field of investigation is 
so vigorously prosecuted m all parts of the civilized world, that 
the literature fairly teems witn bacteria, baccilli, micrococci, 



DUTY OF STATE TOWARDS MKDICAL PROFESSION. 293 

etc., as the causes and carriers of disease, the rank exuberance 
of which will be duly corrected bj the control experiments of 
the critics. The scientist and the practitioner meet in sanitary 
conventions all oyer the land, locai and national in character, 
to prosecute sanitary science collectively. The medical profes- 
sion has primarily advocated the estaolishment of boards of 
health, and is yet constantly calling for these boards where 
there are none. In most civilized lands these boards are now a 
factor of vast importance in preventing and restricting epidemic 
disease. These Boards have been endowed with an authority 
rendering them autocratic in character, .and withal, their 
weapons consist of the mild, persuasive argument of a positive 
knowledge of the causes ana modes of spreading of aiseases. 
All these forces are factors in state medicine; and the progress 
made in this field since the immortal discovery of Jenner to 
the inductive innoculations of Pasteur, and the resplendent 
achievements of Koch, would form a theme in itself far beyond 
the scope of this paper. Yet, what reward does the investi- 
gator receive. for his labors so often performed amidst dangers 
as great as those of the battlefield? No patent with its rewards 
awaits him. If his results have successfully passed the exact- 
ing scrutiny of the control experiments of hundreds of critics, 
he is generously accorded the fame of priority, and free from 
pecuniary consideration, the community reaps the direct bene- 
fits resulting from his discovery in the field of preventative 
medicine, and his profession is so much the loser in profitable 
practice. 

When trades and industries meet in council, the subjects 
-discussed pertain to the means of best promoting trade. I 
have yet to hear of Apy such association discussing the subject 
of restricting trade, unless for concocting a corner. 

These thoughts may seem harsh in tnis hall, where medical 
-science is taught for science's sake, but nevertheless it is neces- 
sary to reach the bottom of an abscess in brder to restore 
healthy tissue in place of the foul gangrenous sore. 

Preventative medicine, with its pernicious results on prac- 
tice, forms, however, but a small fraction of the work performed 
by the profession in the study of diseases and their treatment, 
every progressive step of which results in direct benefit to the 
public. As an illustration of the extent of benefit arising to 
the public from the progress in the treatment of individual 
diseases, I briefly refer to inflammatory rheuihatism. Before the 
action of salicylic acid and iodide of potassium in rheumatism 
was known, the patients were treated for a period of from four 
to six or more weeks with alkalies, then for a similar number 
of weeks with tonics, and if the case was successful, the patient 
was dismissed after three or four months, generally with a 
valvular lesion, as a. memento mori for the rest of his days. At 
present, in the majority of cases, the patient is usually at work 



294 DUTT OF STATE TOWARDS MEDICAL PROFESSION. 

inside of three weeks from date of attack, if properly treated. 
Thus one can readily compute the difference, both in direct 
expense, and from loss in business saved to the community in 
the treatment of this single disease. From the great number 
of cases of rheumatism monthly reported by the state board of 
health, which reports cover but a small fraction of the number 
of cases in the state, I am of the opinion that the people of this 
state save annually more from the progress in the treatment of 
this disease, than the entire university costs the state annually. 
The profession, always mindful "of her duty, is fiir from 
complaining, but nevertheless, she is fully conscious of the 
work done for the good of man, without money ani without 

Erice, a work, which, in its grand aggr^ate, rises mountains 
igh above all pecuniary computations. And to-day, as in the 
days of the Chamberlaines, she would point the finger of indig- 
nation and rightful scorn, on one who would withhold valuable 
knowledge for the sake of personal gain. 

From these few facts of everyday observation, one beholds 
the intimate relation between the advancement of the medical 
profession, and the general welfare of the community. A 
relation, the advantages of which are so general, and so free as 
the blessings of heaven, that they are overlooked, and lof 
behold! the profession must be charged with receiving doM 
favoritism if the state, perchance, gives a few paltry dollars 
annually to the support of this department. 

When every progress in medicine and suijgery is directly 
accompanied with pecuniory savings to the sick; when with 
almost every step in preventative medicine the disease is either 
prevented or restricted in its ravages to the location of origin; 
when, with every step of progress in general miedicine, the 
duration of a disease is shortened and the death rate lessened, 
and in surgery by means of antiseptics, inflammatory compli- 
cations of septic origin almost completely avoided — all factors, 
forming in their grand aggregate a source of wealth to the state,, 
which can be computed in dollars and cents — ^and when, then, 
in connection with these facts, it is borne in mind that the 
schools are, in the great majority of cases, the centers of this 
progress in medicine and surgery, then the charge of class 
favoritism must fall, for the state is annually receiving an 
income from the capital invested, which in its grand lotal rises 
far beyond all commercial computations, and the rate of which 
must increase in direct proportion to every progress made in 
the vast field of medicine and surgery. 

No one will probably seriously question the right of the state 
to demand of those, in whose care the life of the citizen is so- 
often placed, that they shall be possessed of such mental train- 
ing as is essential for conducting logical thought, and that they 
shall be fully abreast with the general advancement of the^ 
jOlence and art of medicine. 



DUTY OF STATE TOWARDS MEDICAL PROFESSION. 296 

In my opinion a government which demands as thorough a 
training of the men who are to fight disease, as it demands of 
her soldiers, is giving the best possible protection to the citizen 
in times of peace, as well as in times of war. And, it is in those 
countries in which the training of the physician and surgeon 
is as rigid as that of the soldier, that medicine has developed 
her greatest achievements. European states demand this stand- 
ard of their physicians and surgeons, and there we find the 
schools under state control, with one standard for all in the 
empire, the standard of the state examination. 

in America, until recently there was no standard of profes- 
sional training demanded by the state. Here the schools are 
under professional control, with weU-nigh as many standards of 
qualification, both in matriculation and final examination, as 
mere are schools in the land. 

That our country has produced men, who have stood in their 
day, and those who stand to-day, second to none in their respect- 
ive departments, is no argument in favor of the non-interfer- 
ence doctrine of the state in professional education. True genius, 
that is, hard systematic work, knows no bounds, and will through- 
out time rank with the great in the profession. But the great 
mass of the people must depend on tne rank and file of the pro- 
fession for medical servicesj and here it is not only the right, 
but the duty of the state to demand a thorough professional 
education, and an independent state examination, before the 
license to practice is granted. When the people have come to 
comprehend this fact, that their interests lie in a rigidly con- 
ducted medical education, and an independent state standard 
of qualification, it will not be long before American schools are 
fully abreast, in all departments, with the verjr best of Europe. 
The times are indicative of a gradual awakenmg of the people 
to their interests in medical affairs. 

As the profession in the United States has so far had supreme 
control over the schools, that is, if the resolutions and demands 
of the county and state societies, and national association, as 
recorded from year to year in the transactions without power of 
enforcement, beyond the force of argument, can be designated 
with the word " control," then the people have not only the 
right, but in their interests it becomes an imperative duty to 
judge the competency of the profession to teach medicine by 
the proficiency of these schools, for it is far too frequently not 
merely a question of dollars and cents, but a question of life or 
death. This question has been thoroughly investigated by the 
Illinois State Board of Health, and the reports of this board 
speak a language that cannot be misunderstood,— they report 
a fact which the people will ere long comprehend in its full 
meaning. 

According to these reports there are one hundred and six- 
teen medical schools in existence in the United States, and 



296 DUTY OF STATE TOWARDS MEDICAL PROFESSION. 

eightyeieht schools have ffone out of existence. Thus this 
country has had two hundred and four medical schools in a 
period of not over eighty years. This certainly shows ^eat 
activity of some kind m medical circles, but this fj^reai activity 
is accompanied with some startling disclosure*). Dr. E. Y. Nel- 
son, of Delaware, Ohio, in a paper entitled "The Relation of 
the Literary to the Medical Colleges," printed in the Journal of 
the American Mediccd Association^ Volume IV, page 255, states as 
follows : '* Some months ago I received a letter from a warm, 
personal friend, himself a member of the Illinois State Board of 
Health, and the one to whom was committed much of the labor 
of compiling their report, though his name does not so appear. 
From him I obtained, as it were, an inside view of these mat- 
ters, and gleaned certain facts not discernible in the published 
reports, at least not without much study and very careful com- 
parisons. In the prosecution of their work they have found it 
necessary to adopt a schedule by which to grade the medical 
institutions of the country. According to that standard there 
are in the United States ten first-class medical colleges. A list 
of these accompanies the letter." And Dr. Nelson adds, that 
not one of these colleges is located within the border of the 
great state of Ohio. 

In a quarterly report of April 1«J-17, 1885, kindly sent me 
by the Secretary, Dr. J. H. Ranch, I see the following state- 
ment: "Although seventy-eight medical colleges out of the 
one hundred and sixteen in the United States, claim to have 
exacted at their last session, a preliminary educational require- 
ment as a condition of matriculation, the evidence afforded by 
the applications thus far received goes to show that in too 
many cases the standard of such education must be very low." 

These reports of the Illinois State Board of Health unfold 
the deleterious result of leaving the medical education of the 
land solely in the hands of the profession, and that too in the 
case of a profession, which in the service of the government has 
reared a monument to medical and surgical science in her 
" Medical and Surgical History of the War of the Rebellion," 
which according to the German medical press, stands unsur- 
passed in the solid excellency of its every departure and 
improvements in the manifold conditions of war. And, under- 
stand, that the medical press of Germany renders this compli- 
ment after comparing the first volumes of the "Medical and 
Surgical History of the Franco-German War," with the Ameri- 
can work. 

I am not here to dwell on the etiology of this sad case of 
medical cachexia. I am here to defend in my humble way, both 
the state and my alma mater against an accusation which is 
false in principle, and against a doctrine which is pernicious in 
practice, alike, in its deleterious effects on the welfare of the 
general public, and the highest interests of the medical profes- 



DUTY OF STATE TOWARDS MEDICAL PROFESSION. 297 

sion. A profession which in its every progress towards truth, 
works in the highest interest of the commonwealth, and which, 
in my opinion, should be carefully protected in its schools 
from the storms of adversity. Human nature will always 
remain true to its selfish instincts of promoting personal aggran- 
dizement, and this powerful factor, uncontrolled in its sway, 
has exerted its baneful influence on the medical schools of our 
•country, and thus, instead of being centers of learning and of 
original research, they have in too many instances become 
purely commercial concerns. In my opinion, the time has come 
when the people should call an imperative '^ Haiti" through 
legislation. 

When comparing the record of the medical schools in the 
United States solely under professional control, minus the legal 
authority of enforcing demands, with the state schools of Euro- 
pean countries, I cannot come to any other conclusion than 
that both the interests of the profession and of the people are 
beet served with the schools under state control. The interests 
of the profession as I understand them, consist in the assur- 
ance that an adequate preliminary education is rigidly exacted 
of every matriculant, that the work of the school is thorough, 
and finally that the diploma is a guarantee of a successfully 
passed, rigid and exacting final examination in all branches of 
medicine and surgery. In a thoroughly equipped and rigidly 
conducted state school, these interests of the profession are 
under the control of the best medical and surgicul talents 
obtainable, and the work is conducted uninfluenced by selfish 
considerations of whatever nature, beyond the requirements of 
science. 

The governments of Europe and the advanced nations of 
other lands, have adhered to the experience of the hoary past 
in keeping the medical schools under state patronage and state 
control. The United States have departed from this path 
hitherto trodden by the nations and empires of historic time 
and left their medical schools solely under professional control 
and management. In the one case the schools have remained 
few in number, yet amply sufiicient to supply all professional 
demands of the land, with a standard of qualification both for 
•entrance and exit, which is fully abreast with the demands of 
the times. In these lands the schools are all centers of original 
research and investigation, centers of progress in the vast and 
ever widening domain of medicine. 

In the United States, schools have sprung into existence with 
startling rapidity, and almost as many as now remain have 

?;one out of existence, without having left a monument in the 
iterature of medicine, of progress made in the advancement of 
medical science. The number of schools in our country cannot 
be far from the number of schools in all Europe. At the present 
rate of progress it will not be long before every one hundred 



298 DUTY OF STATE TOWARDS MEDICAL PROFESSION. 

inhabitants in the land can have one doctor all to themselves 
to look after their precious health. When the standard of quali- 
fication and the original work of the schools, with some honor- 
able exceptions, this department included, are compared with 
European schools under state control, every unprejudiced 
mind must come to the conclusion, that the medical history of 
' the United States corroborates the experience of the ages in 
having the schools under state control in the interests of the 
people, and the profession; all sentimental vagaries of liberties 
guaranteed by the constitution notwithstanding. 

Medicine, cosmopolitan aa astronomy, when once understood 
in her direct bearing on the welfare of the people, that is, when 
the people of our country have come to comprehend the science 
and art of medicine, independent of the personality of the prac- 
titioner, will receive the same cordially offered royal support 
towards promoting her progress, as is offered by the nations of 
Europe, and the people will in turn demand practitioners 
trained to logical thought, and fully abreast with all her 
advancements. Then it will not be considered as a question of 
dollars and cents by the people when their attention is called 
to the needs of the schools, out as a question of principle in 
promoting that sci^.nce which of all the sciences stands nearest 
to man. 

In conclusion, I cannot refrain from giving public expres- 
sion to some thoughts which have been far irom pleasant ta 
follow to their inevitable conclusions. From time to time I 
have read and listened to the sages and philosophers of our day, 
reviewing and analyzing existing forces, which with an unerring 
certainty are rapidly progressing toward a revolution, not simply 
directed against existing forms of government, but potent willi 
destruction to civilization itself. Such forces can be met only 
by an education rounded in itself, and permeating the lowest 
depths of humanity. Of late years, and particularly during the 
last session of our state legislature, these sad thoughts nave 
been aroused from time to time, as hundreds of thousands of 
dollars have been voted with a lavishness unparelleled in the 
history of our state, for supporting and educating the defective, 
demented and criminal classes, and the erection of grand piles 
for their domiciles. All this royal generosity granted by a legis- 
lature which was practically deaf towards the want of the Uni- 
versity, and voted almost begrudgingly the bare necessity of the 
institution in the last days of its session. 

Our constitution can only rest with safety on the intelligence 
of the nation, and the great practical education of the great 
masses can only be accomplished as long as the professions are 
composed of those who have sprung from the common people, 
and are still of the common people, blood of their blood, feeling 
and administering to their every want. 

From causes, more or less directly traceable to the halls of 



MICHIGAN STATE MEDICAL SOCIETY. 299 

congress, and state legislatures, factors have arisen in the land, 
separating the people into two great classes, rich and poor. 
Now, let another factor arise, separating them into learned and 
ignorant, and you will inevitably have on the one hand the rich 
and educated, and on the other the poor and ignorant: but 
remember, that mighty force, which constitutes the arm oi pro- 
ductive industry, knows full well the causes which have led to 
this deplorable state of affairs, and is fully conscious of its 
strength, irresistible when. once organized. 

Charity towards her wards is a noble attribute of a nation's 
character; a humane protection of her defective, demented and 
criminal classes is a high characteristic of an advanced civili- 
zation; yet when these dispensations of a state rise to royal 
munificence when compared with her support, granted almost 
grudgingly towards the pressing wants of her great Universitv 
— ^that institution which of ail institutions in the land, both 
represents and promotes the verv principles on which the con- 
stitution of the nation was founded, and must rest throughout 
time — then it becomes high time to take a careful bearing of 
the course of the ship of state. 



GENERAL CORRESPONDENCE. 



THE MEETING OF THE MICHIGAN STATE MEDICAL SOCIETY. 



The last meeting of the Michigan State Medical Society 
contained so many unusual and pleasant features, as seen from 
the writer's stand-point, that he is constrained to give them to 
the readers of your valuable journal that were not privileged 
to be present. The prompt and business manner in which the 
presiding officer opened the society, and the dispatch used 
m disposing of the parliamentary business and the literary 
exercises of the society was commendable in the extreme, and 
showed that a brilliant professional man can wield the chair- 
man's gavel as efficiently as he can handle the surgeon's scalpel. 

The presence of so many distinguished foreign guests upon 
the platform, and the deep interest which they manifested by 
their constant presence at each session, and by their remarks 
and discussion, inspired a degree of enthusiasm in every mem- 
ber present that the participants felt their labors in preparing 
papers were appreciated. But these papers must not be so 
slightingly dismissed. Those that were read gave evidence of 
an unusual amount of investigation and preparation. Much 
of this doubtless was stimulated by the fact that each paper 
had one or more disputants who came with prepared discus- 
sions on the subject. Although the first time for this arrange- 
ment to be carried out at our state society it was most success- 
ful, and added much to the instructiveness of the exercises. 



300 MICHIGAN STATE MEDICAL SOCIETY. 

From the fact that a large number of the papers could only be 
read by title, shows clearly that the profession of the state is 
awakening to the fulfillment of a duty, which in the past htm 
been painfully neglected. That duty consists in taking more 
Interest in the literary portion of the society meetings and 
being less devoted to selfish schemes and intrigues. It was 
deeply regretted by all present that there was not time to per- 
mit of the reading and discussion of all the papers. There are 
none that could not profit from a recital of conclusions drawn. 

It fully repaid one the time and expense in going to Port 
Huron, to hear the unique and witty eloquence of our vener- 
able friend, Dr. Bennett, making his discrimination between 
the ancient, heroic imperical practice of giving ten and fifteen 
i^rain doses of calomel, and the modern, scientific, therapeut- 
ical methods which recommends the administration of fifty 
frain doses of salicylate of soda reapeated everv two hours, 
ike Booth's Hamlet, the full appreciation was Kad onl^ by 
seeing and hearing it. Dr. Bennett was not alone in giving 
those extremely interesting and instructive recitals of conclu- 
sions drawn from the experiences and observations of half a 
century spent in the active practice of medicine. There were 
numerous other semi-centenarians in attendance, in whom the 
spirit was moved to utterance, and the draughts that were 
taken from the streams of professional wisdom which flowed 
from the minds of Drs. Palmer, Brodie, Noyes, Christian and 
others, can probably never be enjoyed again. 

The sessions sped too rapidly. Every one seemed to feel 
that sense of constriction occasioned bv a want of proper time. 
The continuance of such meetings will of necessity extend the 
sessions through three days, or have the papers of the different 
departments' read in sectional sessions. 

Among the numerous distinguished visitors, the constant 
presence of Dr. Hingston, of Montreal, and Dr. Octerlony, of 
Louisville, was notable. These gentlemen engsiged in the dis- 
cussion of several papers, much to the profit anof entertainment 
of the members. Dr. Hingston 's remarks on '* fractures" and 
on the use of choloroform were characteristically clear and 
forcible, and equally eloquent and potential were those of Dr. 
Octerlony on the subiect of "sterility." 

The medical and surgical exhibits that were displayed 
attracted general attention. The William S. Merrell Chemical 
Company, of Cincinnati, are now giving their attention to mak- 
ing "green Tirug fluid extracts." Their salicylate of soda 
made irom wintergreen, is a beautiful clear crystalline salt, for 
which they claim a greater efficiency, and less unpleasant 
effects The Trommer Extract of Malt Company have a new 
preparation for infant's use. The uniform and reliable charac- 
ter of their malt is becoming well recognized. Parke, Davis & 
Company had displayed a great variety of disinfectants. 



I 



DIABETES MBLLITI8. 301 

This firm has anticipated a demand and are ready to supply 
it. The National Pharmacy Association, of Baltimore, were 
freeljr distributing samples of *' mineral earth," a new surgical 
dressing that is coming into use in Eastern hospitals. Mil- 
bum <fe Williamson, of Detroit, exhibited a fine stock of surgi- 
cal instruments and appliances. The many new preparations 
and devices shown by tnese firms illustrated the rapid advan- 
ces and new demands made by the profession, which the man* 
ufacturer is endeavoring to fill. 

The evening sessions were features not to be forgotten, and 
will continue in the memories of all who enjoyed tnem as the 
crowning events of a most harmonious and enjoyable meeting 
of the Michigan State Medical Society. 

The first was made so bv the inventive and masterly address 
of the president, Dr. Donald Maclean, and by the reading of a 
paper by Professor A. B. Palmer on **The Physiological and 
Therapeutical Eflfects of Alcohol." The paper was discussed 
by Dr. Whelan, of Hillsdale, who followed with a paper 
entitled, **The Possibility of a Concurrent Medical Opinion 
upon the Physiological Efiect of Alcohol." The address and 
paper were appreciated and well received by the large audience 
which had come out to hear them. 

The second evening was a marked success in every particu- 
lar. The boat, the lake, the music, and spirits of the merry 
excursionists were in delightful harmony. The Oakland house,, 
its lawns, its bath, its fluid and solid refreshments, its courteous 
managers, could not have been more enjoyable and agreeable. 

It was plainly manifest that a new era was begun in the 
history of the society. An era of harmony, of increased inter- 
est, and of a desire on the part of all to attain the object for 
which the society was founded — the elevation and improve- 
ment of the medical profession. H. 



DIABETES MELLtTIS CURED BY DRINKING VINEGAR. 



Dear Doctor: I wish to report to you a case of diabetes 
which recovered under my treatment in less than two months, 
although I take no credit to myself. The case was as follows r 
Patient, age twenty-six, complained of constant thirst and 

Eassed nearly two gallons of urine every twenty-four hours-r- 
ad to get up in the night quite frequently. This condition 
had been constant a week or two before calling on me. He also 
stated that his eyes seemed to be failing as everything appeared 
dim. I at once tested his urine, — result as follows: Specific 
gravity, 10:30; sugar very ttbundant; did not make quantitative 
test. I put him K>r two weeks on buttermilk, withdrawing all 
other food and drink, but as he complained of growing weak 
under this treatment I put him on a regular diabetic diet with 
bran bread. With this treatment I nad the satisfaction of 



302 DIABETB8 MELLIT18. 

seeing my patient slowly improving. Sugar still abundant, bat 
quantity of urine passed in twenty-four hours two and a half 
quarts. Specific gravity still 10:30. Thirst still quite urgent. 

This treatment was continued for one month, at the end of 
which time my patient came in one day complaining of his 
thirst and said he wanted some vinegar. I directed him to get 
some cabbage and use vinegar on it. As he failed to find the 
cabbage he filled a glass one-third full of vinegar, the rest with 
water and drank it. This seemed to act nicely in quenching 
his thirst, so he continued it as a drink for one week, at the end 
of which time I examined his urine and found not a trace of 
sugar. Specific gravity, 10:22; quantity, two quarts in twenty ; 
four hours. 

Although two months have passed, he has had no return of 
his trouble, and now he is out working on his farm, and slowly 
and cautiously resuming his old diet. I saw him yesterdav and 
he told me that his health was first-rate, and that bran bread 
with milk was just as good a diet as any other kind when one 
got used to it. He takes the specific gravity of his urine every 
day — said it ranges from 10:18 to 10:23. 

If, Professor, you can try vinegar consistently from this 
report, on a case or two I would be very much pleased, as I do 
not want to believe too much from one case. Medicine is too 
full of the fallacy cum Aoc, ergo 'oropter hoc, now to please me. 
I would not take up your valuable time if I thought I would 
soon have another case to try the treatment on. 

Allow we also to thank you for the many valuable thoughts 
which I have gleaned from your lectures. No one can know 
the value of such thoughts, given to them by their professors, 
till thrown out in practice with no one to guide or direct them. 

[The above communication was received by Professor A. B. 
Palmer, from Dr. F. W. Vincent, of Pendleton, Oregon. The 
rapid cure of the case was regarded by the former to be so 
remarkable, that while its occurence and the drinking uf the 
vinegar might be only a coincidence, he feels that it should be 
given to the profession. Since there is no specific remedy or 
no radical treatment for the cure of diabetes ; and as nothing 
is known, in the majority of cases, during the period of trea^ 
ment, of the nature or seat of the lesion producmg the disease, 
any remedy that will relieve the prominent distressing symp- 
toms of thirst and hunger, and reduce the quantity of urine 
and free it of sugar, if it be only in one case, is worthy of fur- 
ther trial and investigation. Taking large doses of vinegar, 
long continued, lowers the organic functions, impairs the nutri- 
tive processes, impoverishes the blood, and produces emacia- 
tion. May not these efiects be the result of the acetic acid 
destroying the production of sugar in the normal nutritive pro- 
cesses? While the cure of this case came by accident there is 
-a rationale in the treatment. — Editor.] 



EGGS OF THE DI8T0MUM HJEMATOBIUM. 803 

ORIGINAL TRANSLATIONS. 



GERMAN LITERATURE. 
Tbamslatu) by J. A. BOBB. Ann Abbob. Michigan. 



THE PRESENCE OF THE EGGS OF THE DISTOMUM HiEMA- 
' TOBIUM IN THE ABDOMINAL ORGANS. 



BY DR. KARTUU8, 
Physician in the Grecian Hospital of Alexandria. 



Since Bilharz* first in 1851 saw the distomum haematobium* 
in Egypt, and described the symptoms of the disease and the 
pathological-anatomical appearances due to them, we have 
received very little new iniormation concerning this interesting 
parasite. Certainly we are indebted to Griesinger,t Cobbold,t 
Leuckart,§ and others respecting the clinical significance ana 
the history of the development of these worms, as this is of 
much importance, but we to this day know but very little con- 
cerning the pathological-anatomical relation, especially the 
presence of these parasites in the isolated organs. 

In the following I will briefly give an account of two cases 
in which I proved the presence of the eggs of the distomum 
hsemotobium in the prostate, kidneys ana liver, as well as in 
those organs in which former investigations found them. 

The intensity, which causes the pathological phenomenon 
due to the distomum, naturally depends upon the number of 

Sarasites in the human organism as well as upon the stage of 
evelopment in which they are found. According to state- 
ments found in the text-books of Leuckart and Cobbold the 
most important organs in which the eggs of the distomum are 
met with, are the l^ladder, ureters and large intestines, while 
the worms themselves are found in the portal vein and its 
branches, in the spleen vein, and in the texture of the veins of 
the rectum, bladder, and mesentery. 

Cobbold mentions that after careful investigation of a great 
number of cases of this disease, he observes that the symptoms 
are characterized in its early stages by a large amount of bloody 
urine, causing burning pain and pressure. With the urine are 
secreted muco-bloody flakes. Gradually the urine becomes 
clearer; yet there always appear a few flakes with the last few 
drops of the urine. A microscopical examination of these 
masses always brings to view a large number of eggs and em- 

♦Bilharz: ZeiUchrift fur WuBcnclu ZqoI.IY ,1^1, Derselbe; Weiner 
Med. ^ ochenschrift. Number IV, 1856. 

JGriesinffer: Qesammelte Abhandlf 1872. 
Cobbold: "The Parasites of Men and Animals.'' 
{Leuckart : " Die Parasiten dee Menschen," 1879, Band I. • 



304 EGGS OF THE DIBTOMUM HiBMATOBIUM. 

bryo of distomum. If a large number of eggs are deposited 
in the bladder it causes the rupture of the capillaries, and this 
renews the hemorrhage. Besides these eggs, broken-down epi- 
thelial and a large number of pus corpuscles are found in the 
urine. Chronic crystitis gradually develops, and at last the 
urine is filled with muco-purulent masses. The cast-off egg- 
shells are often the cause of vesical calculi. If the eggs are 
.deposited in the ureters, the patient will have frequent pain in 
that region. Finally the pelvis of the kidney becomes diseased 
and at last the kidney itself; this causes pyelitis, nephritis and 
not seldom renal calculi. If at the same time the rectum 
becomes involved, then there is developed beside the above 
mentioned diseases, dysentery or diarrhoeal afiections; often also 
prolapsus recti. There is also usually hypertrophy of the 
prostate. When the disease has reached its highest stage, then 
the patient, under various complications depending upon hiB 
constitution, dies. A usual termination of this disease is in 
albuminuria or ursemia. 

The pathological-anatomical conditions of the diseased 
organs appear as follows: In mild cases there is little to be 
observed in the mucous membrane of the bladder ; only here 
and there the capillaries are over-distended, and at the same 
time occasionally are found irregular, small nodules. The larger 
portion of these nodules is composed of eggs of distomum 
which, by a transverse section of the bladder wall, can be shown 
microscopically; besides these places isolated eggs are found 
deposited in the subcutaneous membrane. 

In more advanced cases the nodules are either larger and 
have the appearance of hsemorrhoidal tumors, or they have the 
appearance of villi or fungi, while the bladder wall itself is 
thickened. In other cases these formations are broken off and 
are therefore wanting in places or entirely. For this reason, 
the mucous membrane of the bladder presents in some places 
the most diversified colors. Great regiilarity in the lesions of 
these organs does not generally exist. In many cases the eggs 
are scattered over the whole submucosa, and some of them are 
also found in the mucosa. Usually vesical calculi are found 
which originated from the cast-off egg-shells. 
' In the severest cases the bladder wall is usually very much 
thickened and the organ itself contracted down to a medium 
sized apple. The mucous membrane is either everywhere 
rough and brittle, or covered over with fungous or villous 
structures. Frequently places are found which give rise to 
ulcerations. In those cases where the bladder wall is the least 
thickened, it is the most brittle and appears to be covered over 
with larger tumor- like protuberances. Such bladders are likely 
to become ruptured. If these organs are examined microscop- 
ically, not only are eg^s found in the mucous and submucous 
membranes but also m the muscular layers; they are found 



EGGS OF THB DISTOMUM HJSMATOBIUM. 805 

deposited between the muscle fibres. Perineal, less often vesico- 
rectal, fistulse, originate in these severe cases. 

The prostate is also often enlarged, and in its parenchyma 
the eggs of distomum are found deposited. If, in mild or very 
recent cases the ureters, which presen. changes due to the eggs 
of the didtomum, be followed up from the bladder the changes 
will be found to be very slight or they may be entirely wanting. 
In the more advanced cases, where the eggs have been deposited 
from time to time, the uretera are found to be enlarged, and 
this enlargement usually begins at the pelvic end. Leuckart 
("Die Parasiten des Menschen, Band I, seite 628") declares 
that the cause of the enlargement of the ureters is as fol- 
lows: "In the ureters the eggs are usually deposited in the 
form of a circle, so that the lumen is often so much narrowed 
that it is impossible to pass a sound through it. The natural 
consequence of such a constriction is a dilatation of that part of 
the ureters above the constriction together with the pelvis and 
calices." I consider it doubtful that the constriction and the 
dilatation above it are entirely due to the above described 
deposit, because in the ureters are found to be the least num- 
ber of eggs ; I am much more inclined to believe that this pro- 
cess is a result of the intensity of the diseased bladder. Scat- 
tered red points or true ecchvmoses and haemorrhages are seen 
in the mucous membranes of such ureters. Section presents a 
few eggs; they are mostlv found here in the submucous mem- 
brane and in the lower third of the organ. 

In several cases one or both ureters mav become enor- 
mously enlarged; I have seen cases where the lumen had 
attained the size of the small intestines. In connection with 
this the walls are thickened, and, as above mentioned, are con- 
stricted in several places. There are hsemorrhages in the 
mucous membrane having somewhat the appearance of hsem- 
orrhogic nodules. If cross sections of the ureters be examined 
microscopically, it will be discovered that the eggs are depos- 
ited all the way up to the pelvis; but they are not so numer- 
ous in the submucous membrane as in the same tissue of other 
organs. They are also relatively very few in number both in 
the mucous membrane and muscular layers. 

The condition of the kidneys is very serious in the different 
stages of the disease ; very often only one kidney is affected, 
yet in most cases both become diseased, especially in those 
cases in which vesical calculi art^ present at the same time. 
Renal affections comprise, according to the intensity of the 
disease, parenchymatous nephritis, cystic formations, calculi 
deposits, cirrhosis, and hydronephrosis as different inflamma- 
torv stages. In several cases the entire parenchyma of the 
kidney shrinks, the organ takes on a bag-shaped form and 
often presents the appearance of a tumor larger than a fist, 
which extends out from the pelvis and calices and forms one 

T 



306 EQG8 OF THE DI8T0MUM HAUATOBIUM. 

or more cysts filled with a turbid fluid. The parenchyma in 
such cases is strongly cirrhotic, and may, as can be seen in the 
second case of this communication, also contain eggs of disto- 
mum. 

The mesenteric glands are often greatly enlarged. By sec- 
tion, the substance can be seen to be swollen, dense, and in the 
center marked with distinct haemorrhages. This condition 
was first, as far as I know, communicated by Dr. Zancarol in 
1881, at the Societe des Hapitauz in Paris. 

The liver is an organ which is very much affected by this 

S)ara6ite. While in very mild cases, the parasites are only 
ound in the main trunk of the portal vein, in more severe 
cases they are present in all its branches. It was indeed sus- 

Eected by Leuckart that the eggs were deposited in the liver, 
ut either this organ was not thoroughly examined, or it may 
be possible that they are seldom present in this organ. I 
myself had only two cases in which I could microscopically 
examine the liver, but in both these cases I found the eggs in 
great abundance. The usual change caused by the deposit of 
eggs in the liver appears to be cirrhosis. The eggs are mostly 
found in the ramincations of the portal system, but also, to 
some extent, in the parenchyma, whither it appears by the 
rupture of their walls, they reach the minutest veins. Those 
eggs that are deposited in the parenchyma, for some time are 
densely surrounded by connective tissue. 

The spleen and pancreas, in my cases, were variously 
affected, yet I could not prove the presence of eggs in these 
organs. 

The large intestines, and especially the rectum, often pre- 
sents similar pathological changes, as in the bladder, which 
changes have already been described ; but in the rectum the 
eggs are found to be mostly deposited in the submucous mem- 
brane and only a very few in the mucous membrane. 

The preparations used in this description were obtained 
from two cases, and are as follows : 

Case L — A fellah, thirty years old, was operated upon by 
Dr. Zancarol at the Grecian infirmary, on January 5, 1884, for 
vesical calculi, and died on the 22d of January, under ursemic 
symptoms. The abdominal organs were onfv diseased and 
were in the following condition : Over three hundred worms 
of distomum, from the portal vein and its branches, were 
collected in the liver ; liver ansemic and dense ; pancreas and 
spleen in the same condition ; mesenteric glands swollen; kid- 
neys enlarged to twice their normal size and bag-like in 
appearance: the cyst-like dilatation contained several small, 
black stones, and sand; the parenchyma had mostly disap- 
peared; pelvis and calices enlarged; the upper third of the 
ureters also so much enlarged that a thumb could easily pass 
through them. In the right ureters there were several constric- 



THE STATE MEDICAL SOCIETY. 307 

tion& in the middle of the organ. The vessels in the mucous 
membrane were enlarged, and contained numerous haemorrha- 
ges the size of a pin's head. The bladder was contracted down 
to the size of a medium-sized orange; its wall over one centi- 
meter thick. The mucous membrane was tough, and here and 
there covered by hsemorrhoid-like growths. Prostate very 
large and dense.* Besides in the bladder, ureters, and large 
intestines, I also found the eggs in the mesenteric glands, pros- 
tate, and liver, but only egg-shells in the kidneys. 

Case 11. — A fellah, forty-five years, dissected in the Ara- 
bian hospital by Dr. Scheiss, who permitted me to make a 
microscopical examination of the organs. The following were 
the conditions: Infarcts, caused by the eggs of distomum, 
were found in the capillaries of the submucous membrane of 
the bladder ; also in the muscle wall of the same organ were 
found many eggs. The spleen and pancreas contained nq 
eggs. The liver contained a large number of eggs, and its 
condition generally was the same as in case first. I found 
many eggs, also egg-shells, in the kidneys, some lying in the 
capillaries, and some, due to the rupture of the capillaries, 
were deposited in the parenchyma. Tne substance of the kid- 
ney itself was strongly cirrhotic. 



EDITORIAL PERISCOPE. 



THE STATE MEDICAL SOCIETY. 



The twentieth annual meeting of this society was held in 
the opera house at Port Huron. The meeting was called to 
order at 10 o'clock on Wednesday morning, June 10, by the 
president, Dr. Donald Maclean, of Detroit, and prayer was 
offered by Reverend A. Hastings Ross. The president then 
introduced General William Hartsuff to the assembly, who de- 
livered an address of welcome. The executive committee made 
its annual report which was accepted. The reading and dis- 
cussion of papers was then begun, and continued through the 
different sessions. 



The meeting was especially favored by the great number of 
ex-presidents of the society that were in attendance. But a 
very interesting coincidence was the presence of the first presi- 
dent of the State Society, Dr. Stockwell, of Port Huron, and 
the late chosen president of the American Medical Association, 
as well as ex-president of the society then in session, Dr. Wil- 
liam Brodie, of Detroit. In electing the latter gentleman to 
the presidency of the American Medical Association, a high 
and well merited tribute of respect and honor was deservin^y 



808 dupuytben's contraction. 

Said. His interest in the welfare of the association, and his 
evotion to the profession, which it represents, as shown in his 
long and constant attendance at every meeting, together with 
his long experience as a parliamentarian and his rare executive 
ability, indicated him as a safe and worthy man to preside at 
their next meeting. 

The report of the Committee on Re-organization, as made 
through its chairman, Dr. Johnston, afforded considerable 
entertainment and amusement. It was a rare exemplification 
of consistency as it is exhibited by some individuals. 

The report of the Committee on Medical Legislation was 
made through the chairman, Dr. Smart. After some discus- 
sion it was referred, upon the suggestion of the president, to a 
committee of five, to consider upon the advisability of making 
certain proposed changes in the medical bill which it sub- 
mitted to the society for recommendation. Alter the report of 
the committee, which advised its recommendation as read, the 

i)resident again promptly and effectively prevented a threatened 
ong and unpleasant discussion. 

The meeting was one that will stand conspicious in the 
annals of the society for the number of able papers read ; the 
closeness with which the discussions were confined to the sub- 
jects; the general interest and enthusiasm manifested by all 
present; the hearty welcome by the city ; the delightful excursion 
and the generous hospitality extended by the courteous man- 
ager of the Oakland house; and for the appropriate responses 
to the toasts, the interposed music, with the closing ''Aula Lang 
Syne." 

RAPID CURE OF DUPUYTREN'S CONTRACTION BY EXCISION. 



^he cure of a case of contraction of the palmar fascia is 
recorded by Mr. H. A. Reeves in the British Medical Journal, 
that proves the possibility of speedily correcting this annoving 
deformity, whicn has been considered irremediable or at best, 
very intractable and slow of cure. The case has a further inter- 
est because it occurred in a female, and being the second case 
of this deformity in females which has come under the author's 
observation during the past five months. Though only three 
months have elapsed since the operation, Mr. Reeves claims 
that the case may be considered complete on account of the 
method of operating, which removed the cause of the distortion 
so that no fear of relapse need be apprehended, as the linear 
cutaneous cicatrix is unlikely to retract to any noteworthv 
extent. The finger is perfectly straight and thoroughly useful. 
The history of the case and mode of operation are as follows: 



GERMAN VACCINE COMMISSION. 309 

Mrs. p., aged forty-five years, first noticed a thickening in 
the palm and contraction of her right ring-finger at the age of 
thirty-two. She thought it mi^ht have been produced through 
falling from, and being dragged some distance by a horse, whue 
holding the reins. Shortly after she worked much with a 
sewing machine, and practiced a great deal on the digitorium. 
The contraction increased and when first seen the finger could 
not be but to a slight degree extended. An incision was made 
through the skin down to the band, and along its entire length. 
The skin was then separated from the band which was thor- 
oughly isolated, except at its ends, and was divided at its upper 
ena. The finger was straightened, which, however, was accom- 
plished after the use of some little force, and was accompanied 
Dv two loudish snaps, due to the rupture of some deep fibres. 
Tjne band was then freely excised, ana, after removing Esmarch's 
bandage, as there was no hsemorrhage, the skin-edges were 
Accurately adjusted with fish-gut sutures, and the hand put in 
a long black-splint for the forearm and hand, with the singers 
fully extended. The wound healed by first intention; and 
within three weeks the patient could plav the piano, write 
letters, etc. The finger has continued straight and the use of it 
flo much like the normal that it can be termed perfect It can 
be stated that this is the patient's view of it as well as that of 
the operator. 

''I think," says Mr. Reeves, "the plan I adopted and intend 
to repeat, of excising the offending band, ana removing the 
cause of the contraction is the proper proceeding. Certainly 
the. result in the case narrated is most satisfactory; and, now-a- 
days, we know that cleanliness is all that is necessary in a 
healthy patient to insure good union of a wound, so that the 
former risks of the treatment by open division are no longer 
feared. Before this case was operated on I was strongly in 
favor of subcutaneous division ; but seeing how slow, and some- 
times uncertain, this plan is, and knowing the liability to 
recontraction when the band is left, I have no hesitation in 
stating my belief tiiat excision of the band will be the operation 
of the future when dealing surgically with Dupuytren's con- 
traction." 



REPORT OF THE GERMAN VACJCINE C0MMI88I0N. 



The Vaccine Commission,- which a short time since was 
appointed by the German Imperial Health Society, have 
returned the following report relative to the pathological and 
physiological basis of vaccination : 

(1) A single attack of small-pox, with rare exceptions to 
the contrary, prevents the possibility of a recurrence of the 
disease. 

(2) Vaccination offers a similar protection. 



310 RINGWORM OF THE SCALP. 

(3) The length of time during which vaccination is pro- 
tective against the disease, widely varies, but the average 
period is ten years. 

(4) In order to secure protection against small-pox by 
vaccination, at least two well-developed vesicles must be 
obtained. 

(5) Revaccination is necessary at the end of ten years after 
the first vaccination. 

(6) Vaccination of a community affords a common pro- 
tection against small-pox. 

(7) Vaccination under certain circumstances may be dan- 
gerous, inasmuch as by the use of human lymph, S3rphilia 
mav be communicated. This danger is however slight; and 
with ordinary care can l)e so reduced that the possible harm 
therefrom is incomparable to the actual protection attained 
against small-pox. 

(8) Since the introduction against vaccination there has 
been no disease or unusual morUility, which from a scientific 
stand-point, can be attributed to the effect of the operation. 



THE TREATMENT OF RINGWORM OF THE SCALP. 



The following simple method of treating ringworms of the 
scalp is considered very effectual by Dr. James Foulis, of Edin- 
burgh: 

The child is made to sit down on a chair before a washing 
basin half filled with warm watter ; a folded towel is first of all 
tied round the child's forehead, in such a way that no fluid 
poured on the head can trickle down into the eyes. It is best 
to cut the hair short all round the affected part. If there be 
many spots of ringworm, the whole head may be closely 
cropped. Have ready a two-ounce bottle of common spirit of 
turpentine, an ounce bottle of tincture of iodine, a camel's-hair 
brush, and a two per cent, cake of carbolic soap. While the 
child bends forward over the basin, the spirit of turpentine is 
freely poured over one or more spots at a time, the forefinger 
being used to rub the turpentine well into the scalp. Almost 
immediately the dirt and greasy scabs disappear, and the 
broken hairs are seen to stand up like bristles. Generally, in 
about three minutes' time the child cries out, *' Oh, it nips ? '^ 
then we know that the turpentine has penetrated deeply. 
Immediately, the piece of carbolic acid soap is well rubbed into 
the parts, which have been acted on by the turpentine, and 
warm water is freely applied to make this soap mto a lather, 
by which means the head is well washed, and soon appears to 
be beautifully cleaned. The smarting, such as it is, (]^uickly 
disappears after the application of the soap. The head is then 
well dried with a towel. Common tincture of iodine, in two 
or three coats is now painted well over the affected parts, and 



TREATMENT OF RUN DOWN WOMEN. 311 

allowed to dry. As soon as the hair is dry, some carbolic oil, 
(one in twenty) is rubbed all through the hair to catch such 
speres as may be there. 

This treatment, applied every morning, or morning and night 
in very bad cases, generally cures the worst cases in the course 
of a week. During the last five years, I have used no other 
method of treatment. The explanation of its success is as fol- 
lows: Oommon spirit of turpentine is a powerful germicide, 
but is a still more powerful solvent of the sebaceous or grestsy 
matter of the scalp, and it rapidly penetrates into all the epith- 
elial structures of the scalp, the affected hairs included, and 
clears the way for the application of h still more powerful 
germicide, namely, tincture of iodine. It is an important 
chemical fact that the spirit of turpentine, or, more correctly, 
oil of turpentine, is a powerful solvent of iodine. This solution 
of iodine in turpentine is a most powerful vermicide, and 
quickly destroys the fungus of ringworm. If tincture of 
iodine be applied to the spots whicn have been treated, as 
above, first with the spirit of turpentine, and then washed 
with carbolic acid soap and water, it finds its way down into 
the epithelial tissues, and into the hair follicles, following the 
course which the spirit of turpentine has taken. It is of no 
use to apply watery solutions of germicides, until the greasy or 
sebaceous matter of the scalp has been first removed. In some 
severe cases, I have applied a solution of iodine in turpentine, 
ten erains to the ounce, instead of the tincture of iodine, after 
the head has been washed and cleaned ; but in most cases the 
application of tincture of iodine, after the parts have been 
acted on by the spirit as above described, is quite sufficient to 
destroy the disease. 

Ringworm on other parts of the body may be treated with 
spirit 01 turpentine and tincture of iodine in exactly the same 
way. One great advantage of this treatment is that it may be 
applied to the head of the youngest child, and causes littlis or 
no distress at any time. 



TREATMENT OF RUN DOWN WOMEN. 



The expensiveness of rest cures is a great objection met in 
their use in the treatment of cases where exists grave nervous 
disorders, due to want of vitality and loss of tonicity. But it 
is strongly recommended by Dr. Horatio R. Bigelow (Obstetric 
Oazette) in cases where women are " run down," whether the 
impaired^ condition be due to sexual derangements or not. 
Such patients are put to bed, with a reliable nurse, when such 
can be afforded. The house is kept quiet. No company, read- 
ing, work, or correspondence allowed. The most perfect bodily 
rest and mental quietude are aimed at. The eeneral health is 
now built up through careful feeding. Small quantities of 



312 CONDENSATIONS. 

easily digested food are ^iven at regular and frequent intervals. 
Mellin's tood is used at the commenoement. Even when con- 
stipation, harsh dry skin, coated tongue, foul breath, and weak 
irregular heart action exist, aperients are not to be used. The 
int^tines are allowed to partake of the general improvement, 
and normal tonicity and peristalsis results. Muscular Faradiza- 
tion and massage to be employed three times a week. 



CONDENSATIONS. 



Hypodermics of ether are used by Bartholow to tide over 
the crisis in typhoid pneumonia. 

Dr. S. J. Gee recommends a douche of hot water to the 
spine in cases of spinal irritability. 

The muriate of cocaine, which has been found so efficient 
in the vomiting of alcoholism, has no effect in relieving the 
vomiting of early pregnancy. 

Leucorrhcea in young girls of from ten to sixteen years old. 
has been traced by a correspondent of the Boston Medical ana 
Surgical Reporter to excessive indulgence in roller skating. 

The New York Medical Record says that tobacconists in New 
York city admit that since publicity was given to General 
Grant's case, there has been a considerable falling off in the 
number of cigars sold in that city. 

Mercury is contra-indicated in syphilis: in phthisis, except 
when very slight; in nephritis, except when due to Sjrphilis; 
in severe scrofulous symptoms; in profound non-specific an»- 
mia; in sloughing anci phagedena. 

British surgeons are givinjK up the routine use of choloro- 
form except with children. They regard a mixture composed 
of one part, by measure, of alcohol to two parts of choloroform 
and three of ether to be much safer. 



The taste and smell of turpentine are best masked by sul- 

Shuric ether. A mixture of turpentine, two drachms; ether, one 
rachm; syrup of orange, one ounce; and water, four ounces, can 
be taken in teaspoonful doses quite readily. 

At a recent congress of German surgeons, von Hacker 
announced that of eighteen cases, in which Professor Billroth 
had performed resection of the pylorus, there was but a single 
one in which the result could be called favorable. 



CONDENSATIONS. 818 

FiR8T-€LA88 niedals were received by the Mcintosh Galvanic 
:and Faradic Battery Company for their display of electrical 
^oods at the World's Fair and Cotton Exposition, and for their 
<x>mbined solar microscope and stereopticon. 

Professor P. L. Panum, of Copenhagen, the President of the 
International Medical Congress, recently held in that city, died 
suddenly, May 2. His death will be much regretted on the 
western as well as the eastern side of the Atlantic. 



At an April meeting of the New York Academy of Medi- 
<sine. Dr. Markoe presented to that body, in the name of the 

fenerous givers, the Astors, a beautiful oil portrait of Fordyce 
tarker, M. D., LL. D. The paintin? represented the ex-Presi- 
•dent in his academic robes. 

RoBSBAOH claims that of thirty-five cases of typhoid fever 
treated with naphthaline (five grams daily) fifty per cent, took 
a clearly abortive course^ while no secondary effects were caused 
by the drug. This is the latest medicine used by German 
-experimenters, for which abortive properties are claimed in 
typhoid fever. 

An inhalation for coryza is recommended in the Union Med- 
idtile by Dr. Hager, composed of pure carbolic acid, one hundred 
and fifty grains; ammonia water, three drachms: alcohol, one 
ounce; distilled water, five drachms. A piece or cotton satu- 
rated with this mixture is placed in a wide-mouthed bottle, and 
the vapor is inhaled. 

A CORRESPONDENT of the North Carolina Medical Journal, 
reports an interesting case in which the secretion of milk was 
^eatly stimulated by eating oranges. To test the effect, the 
Sruit was omitted for a few days, when the secretion ceased. It 
was soon brought on, however, bv a return to this fruit diet. 
If at any time the flow be not free, one or two oranges will 
increase it very abundantly in an hour or two. Previous to 
using the oranges the patient gave no milk and the child was 
fed artificially. 

In Bellevue Hospital the temperature of typhoid patients is 
not allowed to reacn 103^ Fahrenheit It is kept below this 
point by the use. of alcohol sponge baths. If the temperature 
rises above this limit antipyrine, twenty grains; whiskey, one- 
half ounce; tincture digitalis, five minims, are administered. 
If the patient is not getting cool and moist in an hour, the 
antipynne and whiskey are repeated. Water baths are used 
in combination with the alcohol sponge baths, and the metallic 
coils are found useful. 



314 CONDENSATIONS. 

The Boston Medical and Surgical Journal contains the infor- 
mation that Dr. Buchanan was again found ffuilty by a jury at 
Philadelphia, of issuing bogus medical diplomas. A woman 
named Russell, who was tried at the same time with him, wa£( 
acquitted on the criminal charge. She testified that although 
she displayed a sign as a doctor, she had graduated from no 
medical school, and that the "M. D." following her name meant 
" Money Down." 

I!)r. a. L. Loomis says : "A man can take two or three glasses 
of stimulants through the day, as he may feel an inclination, 
and he may continue this for perhaps twenty-five years with- 
out any harm accruing from it : but when this man reachea 
that period of life when the vital powers are on the decline^ 
he suddenly feels himself growing old before his time, for he 
has all these years been laying the foundation for chronic 
endoarteritis. I believe that fifty per cent, of all diseases arise 
from the use of alcoholic stimulants." 



The AnncUs of^ Surgery for June contains the following valu- 
able original articles: '^Further Observations on the Treat- 
ment of Stone in the Bladder," by Reginald Harrison, F. R. G. 
S., of Liverpool, Surgeon to the Liverpool Royal Infirmary ; 
*' An Experimental and Clinical Study of Air Embolism, bv K . 
Senn, M. D., of Milwaukee, Wisconsin; '* Sponge-Grafting," by 
J. Burnett, M. D., of Carbondale, Pennsylvania; ''Erosion of 
Internal Carotid Artery During Scarlet Fever — Hsemorrhages 
from External Auditory Meatus — Ligature of Common • Carotid 
— Recovery," by Bennett May, F. R. C. S., of Birmingham^ 
Surgeon to the Queen's Hospital of Birmingham. 

In the treatment of typhoid fever the local medication of 
the intestinal lesions, constitutes a very important factor. The 
oil of turpentine is a remedy that has a powerful and direct 
action over the abdominal symptoms. In the second week of 
the fever, when the tongue is brown and dry, the good efi*ect& 
of the turpentine is especially manifest. The oil has a Ren- 
erally stimulating action, and when given in the form oi an 
emulsion it is slowly absorbed, and being rapidly volatilized^ 
the canal is filled with the vapor. It thus acts direcUv upon 
the ulceratious, and also prevents decomposition and fermen-- 
tation of the intestinal contents. 



In a paper on the "Origin and Prevention of Typhoid 
Fever," published in the Sanitary News, Dr. J. Francis Suther- 
land, of England, takes the ground that typhoid fever is not 
due to a specific germ ; that its cause is found in a non-specifie 
germ, which he designates as the sewage per se germ. This 
germ is the result of fermentation and decomposition, and 



/ 



CONDENSATIONS. 815 

abounds in sewers, cess-pools, and privies. When taken into 
the human system they multiply and become virulent and 
produce the symptoms of typhoid fever. When expelled from 
the body they are inert, but in a favorable medium where fer- 
mentation and decomposition take place they become danger- 
ous, and when inhaled or swallowed, establish the disease. 

Antipybine. — In further confirmation to the testimony, 
which the profession already possesses, Dr. G. B. Butler reports 
in the New York Medical Journal the results of a number of 
cases in hospital practice, where he employed antipyrine as 
an antipyretic. He gives the following summary as the results 
of his experience: (1) Antipyrine is a certain, safe, and pow- 
erful antipyretic, but is not an antiperiodic; (2) It is especially 
useful in typhoid fever, pneumonia and phthisis^ (3) The 
reduction of temperature occurs rapidly, and persists for an 
average of twelve nours; (4) Its dose is double that of quinine, 
thirty grains being the usual maximum dose for an adult. 
Half the quantity may be given subsequently at intervals of 
one, two, or three hours, according to indications. 

A THEORY explaining how vaccination works is given by 
Professor Tyndall in the Popuiar Science MontMy for May. He 
refers to the little difficulty experienced by Pasteur in estab- 
lishing the parasitic origin of fowl-cholera, for indeed, the 
parasite had been observed by others before him, but by his 
successful cultivations he rendered the solution sure. '^Hi& 
next step," says Tjrndall, " will remain forever memorable in 
the history of medicine. I allude to what he calls ' virus atten- 
uation.' And here it may be well to throw out a few remarks 
in advance. When a tree, or a bundle of wheat or barley 
straw, is burned, a certain amount of mineral matter remains 
in the ashes — extremely small in comparison with the bulk of 
the tree or of the straw, but absolutely essential to its growth. 
In a soil lacking or exhausted of the necessary mineral con- 
stituents, the tree cannot live, the crop cannot grow. Now^ 
contagia are living things, which demand certain elements of 
life just as inexorable as trees, or wheat, or barley : and it is 
not aifficult to see that a crop of a given parasite* may so far 
use up a constituent existing in small quantities in the body, 
but essential in the growth of the parasite as to render the 
body unfit for the production of a second crop. The soil is 
exhausted, and, until the lost constituent is restored, the body 
is protected from any further attack from the same disorder. 
Such an explanation of non-recurrent diseases naturaHv pre- 
sents itself to a thorough believer in the germ theory, and such 
was the solution, whicn, in reply to a question, I ventured to 
ofier nearly fifteen years ago to an eminent London physician. 
To exhaust a soil, however, a parasite less vigorous and 



316 NEW PUBLICATIONS. 

cleBtructive than the really virulent one may suffice; and, if^ 
after having by means of a feebler organism exhausted the 
soil, without fatal result, the most highly virulent parasite be 
introduced into the system it will prove powerless. This, in 
tiie language of the germ theory, is the whole secret of vacci- 
nation. 



NEW PUBLICATIONS. 



SANITARY SUGGESTIONS ON HOW TO DISINFECT OUR 
HOMES. A Resume of the Latest and Best Information on the 
Hoiipehold Use of Disinfectants, Deodorants and Antiseptics— 
and of Practical Precautions Preventive of Cholera, Diphtheria, 
Scarlet Fever» and other Infectious Diseases. Prepared for Popu- 
lar Perusal. By B. W. Palmer, A. M., M. D. Price, 25 cents. George 
S. Davis, Detroit, Michigan. 

The object of this little book is to briefly present the most 
■approved agents for the prevention of infectious diseases, point 
out the necessity for their use, and explain their application. 
It contains concise practical suggestions and instructions for 
improving the sanitary surroundings of the home and the best 
means for keeping tnem in good condition. The principle 
<K)ntained are based on the latc'st researches of the most emi- 
nent sanitary authorities. 



-CLINICAL STUDIES ON DISEASES OF THE EYE, INCLUDING 
THOSE OF THE CONJUNCTIVA, CORNEA, SLEKOTIC, IRIS 
AND CILIARY BODY. By Dr. Ferdinand Retter von Arlt, Pro- 
fessor of Ophthalmology in Vienna. Translated by Lyman Ware, 
M. D., Surgeon to Illinois Charitable Hospital, and the Protestaiit 
Orphan Asylum, Chicago- 8mo; three hunlred and twenty-five 
pages. Price, $2.50. Philadolphin : . P. Blakiston, Sou & Com- 
pany, 1885. 

Within the past few years the translating of foreign books 
into the Englisn by American teachers and practitioners, has 
become of frequentoccurrence. We are thus privileged to read 
in clear English construction the best foreign authors almost 
^simultaneous, or at most but a few months after their original 
publication. Both the specialist and general practitioner are 
indebted to Dr. Ware for the early translation of Professor Arlt's 
latest work. "Writing," says the translator, "in the era of a 
long and useful career, the author has embodied in his * Clinical 
Studies' the very essence of his mature experience, which 
reaches over almost half a century of ophthalmic practice." 
The author has designed to give the physicians engaged in 
general practice a book of reference which they could consult 
regarding the common and most frequent diseases of the eye. 
''^ I also hoped," says the author, "that I could induce them to 
reflect more upon the morbid processes, and to inquire into 



/ 



NEW PUBLICATIONS. 317 

their exciting causes." It is to be regretted that on account of 
declining health Professor Arlt could not collect and systemat- 
ically arrange all of his clinical lectures. 

Dr. Ward is to be congratulated upon the success with 
which he has preserved the distinctive original features of the 
work. The translation is remarkably free from interpolations. 
While it is a literal translation the German sentences and 
phraseology have been rendered in even, well-rounded English 
expressions. 

The great experience of the author, together with that 
quality of mind, to sharply discern and clearly describe the 
prominent features and principles of his science, has enabled 
him to give the profession a work upon which a greater degree 
of confidence can be placed than many others produced under 
conditions much less favorable. 



BERLIN AS A MEDICAL CENTER : A GUIDE FOR AMERICAN 
PRACTITIONERS AND STUDENTS. By Horatio R. Bitfelow. M. 
D., Member of the American Medical Association ; of the Med- 
ical Society and Medical Association of the District of Columbia; 
of the Anthropolo^cal and Biological Societies of Washington, 
Dintrict of Columbia. Reprinted from the New EngUmd Medical 
Monthly, Sandy Hook, Connecticut: New England Publishing 
Company, 1885. 

This little book is the product of a series of letters pub- 
lished in the New EngUmd Mediccd Monthly^ and constitu^s a 
thorough guide for American medical students in Berlin. 

It furnishes a concise and exhaustive set of directions, 
embracing all necessary detail from time of departure from 
America up to the time of returning. The topics discussed 
are: (1) What it will cost; (2) The arrival and departure — 
(under this is included the arrival at the station of Berlin, the 
temporary disposition of luggage, the selection of room and 
restaurant — or the choice of veneion — if this is preferred, the 
names of different pensionSj hoteU^ garrieSy and of the streets 
near centers of professional work, the law protecting landlords 
relating to payment in advance, the law involving the question 
of the student's surrender of his quarters, the question of fees, 
of fire, light and service, of washing, police regulations, post- 
restomt, etc.; (3) Matriculation, the selection of courses, a tab- 
ulated list ot courses, the addresses of lecturers, the cost of 
lectures, polyclinics and where held, names of hospitals, 
names of medical men at each hospital and at clinics in Tieg- 
elstrasse; (4) Vacation courses: (5) Shopping, where to buy 
and how to buy, what to see ana how to see. 

To those who have in contemplation, or those who have 
decided to receive the particular advantages which Berlin offers 
to the medical student, this little book will be found a valuable 
aid and assistance in determining upon the course of studies 
they wish to pursue. 



1 



318 NEW PUBLICATIONS. 

BOOKS AND PAMPHLETS RECEIVED. 



NEW BOOKS. A Quarterly Publication Devoted to Books^ Showing 

What They Are and Wbere to tjret Them. April. Published by 

H. H. Howe. M. D.. Weston, Vermont, 1886. 
VALEDICTORY. ADDRESS BY THE RETIRING PRESIDENT, 

FORDYCE BARKER. M. D., LL. D., (Columbia and Edinburgh). 

Delivered before New York Academy of Medicine, February 5, 1885. 

ALIPPO BUTTON. By A. A. Altounyan, M. D., Aintab, Turkey. 
Reprinted from the Journal of Cutaneous and Venerea^ Disecues^ 
Volume III, Number VI, June, 1885. New York : Wm. Wood & 
Company, 1885. 

REPORT OF THE BOARD OF TRUSTEES OF THE EASTERN 
MICHIGAN ASYLUM. AT PONTIAC, FOR THE BIENNIAL 
PERIOD ENDING SEPTEMBER 30, 1884. By Authority. Lan- 
sing. Michigan : W. S. George & Company, State Printers and 
Binders, 1884 

THE TEN LAWS OF HEALTH; OR, HOW DISEASES ARE 
PRODUCED AND PREVENTED, AND FAMILY GUIDE TO 
PROTECTION AGAINST EPIDEMIC DISEASES AND OTHER 
DANGEROUS INFECTANTS. By J. R. Black, M. D. Philadel- 
phia: J. B. Lippincott Company. 1885. 

ENDOMETRITIS FUNGOSA : ITS PATHOLOGY, DIAGNOSIS, 
AND TREATMENT. By James B. Hunter, M. D., Surgeon to 
Woman's Hospital, New York; Professor of Gynsecologv in the 
New York PalycHnic, etc. Reported from the Medical Record, 
April 25. 1885. New York : Trow's Printing and Bookbinding 
Company. 1885. 

ELECTRICITY AS A REMEDIAL AGENT. By George C. Pit«er, 
M. D.^ Professor of the Theory and Practice of Medicine in the 
American Medical College, Saint Louis ; Clinical Lecturer at the 
City Hospital, Saint Louis; Editor of the American Medical 
Journal; Author of " Electricity in Medicine and Surgery;" and 
Author of '* Direct Medication— Therapeutics." Saint Louis, 1885. 

BACTERIAL PATHOLOGY. A series of papers on the exhibits at 
the Biological Laboratory of the Healtn Exhibition, under the 
charge of Watson Cheyne. Reprinted from the London LanceL 
Illustrated with over thirty engravings, showing the appearance 
of the bacteria, and the apparatus used in preparing and cultiva- 
ting them. Price. 25 cents. New York : Ttie Industrial Publica- 
tion Company, 1885. 

THE OLEATES : AN INVESTIGATION INTO THEIR NATURE 
AND ACTION. By John V. Shoemaker, A. M., M. I)., Lecturer 
on Dermatoloff)[ at the Jefferson Medical College ; Physician to 
the Philadelpnia Hospital for Skin Diseases; Member of the 
Pennsylvania State Medical Society, the Minnesota State Medical 
Society, the American Medical Association, the American Acad- 
emy of Medicine, the British Medical Association; Fellow of 
the Medical Society of London. Philadelphia: F. A. Davis, 
Attorney, 1217 Filbert street, 1885. 

SPECIALTIES AND THEIR RELATION TO THE MEDICAL 
PROFESSION. By L. Duncan Bufkley, A. M., M. D., Attending 
Physician for Skin and Venereal Diseases at the New York Hos- 
pital, Out-patient Department, etc. Read before the American 
Academy of Medicine at its Annual Meeting at Baltimore, Mary- 
land, October 29, 1884. Approved for publication by the council. 
Reprinted from the Journal of the American Medical AModaHonf 
December 13, 1884. Chicago : Review Printing Company, 1885. 



I 



NEW PUBLICATIONS. 319 

THE INFLUENCE OF SEA- VOYAGING UPON THE GENTO- 
UTERINE FUNCTIONS. By J. A. Irwin, M. A., Cambridge. 
Eneland ; M. A , M. D., Dublin University ; Member of the Royal 
College of Surgeons, England ; Licentiate in Midwifery of King's 
and Queen's College of PhyFicianp, and the Rotunda Hospital, 
Dublin: Fellow of the London Obstetrical Society; Member of 
the Daolin Obstetrical Society, etc. Read before the New York 
County Medical Society, April 27, 1885. New York : Trow's Print- 
ing and Bookbinding Company, 1885. 

URINARY RENAL DERANGE»iENTS AND CALCULOUS DISOR- 
DERS : HINTS ON DIAGNOSIS AND TREATMENT. By 
Lionel S. Beale, M. D., Fellow of the Royal Society and of the 
Royal College of Physicians ; An Examiner of Medicine of the 
Examining Board in England, appointed by the Royal College of 
Physicians and Surgeons ; Professor of the Principles and Prac- 
tice of Medicine, and formerly Professor of Pathological Anatomy 
and Physiology and of General and Morbid Anatomy, in King's 
College, London; Physician to King's College Hospital. Three 
hundred and fifty-six pages. Price, in cloth, $U75. Philadelphia. 
P. Blakiston, Son & Company, 1885. 

HAY FEVER AND ITS SUCCESSFUL TREATMENT BY SUPER- 
FICIAL ORGANIC ALTERATION OF THE NASAL MUCOUS 
MEMBRANE. An Essay read before the Philadelphia Laryngo- 
logical Society, April 24, 1885. By Charles E. Sajous, M. D., 
Instructor of Rhinology and Laryngology in the Poet- Graduate 
and Spring Courses, Jefferson Medical College ; President of the 
Philaoelphia Laryn^ological Society ; Fellow of the American 
Lar^ngological Apsociation ; Corresponding Member of the Royal 
Society of Belgium and of the Medical Society of Warsaw, (Rus- 
sia), etc. Illustrated with thirteen wood engravings. One hun- 
/ dred and three pages. Philadelphia : F. A. Davis, Attorney, Pub- 

lisher, 1217 Filbert street, 1885. 

MEDICAL LEGISLATION : THE ANNUAL ADDRESS DELIV- 
ERED BEFORE THE ASSOCIATION OF AMERICAN MED- 
ICAL EDITORS. By Henry 0. Marcy, A. M., M. D., Boston, 
United States of America, President Association American Med- 
ical Editors; President of the Boston Gynaecological Society; 
Late President of the American Academy of Medicine; Member 
of the International Medical Congress ; Member of the British 
Medical Ascociation; Member of the Massachusetts Medical 
Society; Corresponding Member of the Medico* Chirurgical 
Society of Bologna, Italy, etc., etc. Read before the Association 
of American Medical Editors, April 27, 1885. Reprinted from the 
Journal of the American Medical AssodcUion, May 21, 1885. Chi- 
cago: Review Printing Company, 1885. 

A TREATISE ON THE SCIENCE AND PRACTICE OF MID- 
WIFERY. By W. S. Playfair, M D.. F. R. C. P., Physician- Accou- 
cheur to H. I. and R. H., the Duchess of Edinburgh ; Professor of 
Obstetric Medicine in King's College ; Physician for the Diseases 
of Women and Children to King's College Hospital ; Consulting 
Physician to the General Lying-in Hospital, and to the Evelina 
Hoppital for Children ; Late President of the Obstetrical Society 
of London ; Examiner in Midwifer^^ to the University of London 
and to the Royal College of Physicians. Fourth American from 
the fifth English edition, with notes and additions by Robert P. 
Harris, M. D., with three plates and two hundred and one illus- 
trations; six hundred and sixty-three pagjes. Cloth, $4.00; 
Leather, $5.00 ; Half-Russia, $5.50. Philadelphia: Lea Brothers <& 
Company, 1885. 



320 NEW PUBLICATIONS. 

OVARIOTOM Y. By James B. Hunter, M. D., Sun^eon to the Womeii'» 
Hospital; Professor of Gyo8BColot;y in the New York Polyclinic,, 
etc. Reprinted from the New York Medical Journal for .Tone 7, 
1884. New York : D. Appleton & Co., 1884. 

A PRACTICAL TREATISE ON URINARY AND RENAL DIS- 
EASES, INCLUDING URINARY DEPOSITS ILLUSTRATED 
BY NUMEROUS CASES AND ENGRAVINGS. By William 
Roberts, M. D., F. R. S., Fellow of the Royal CoUeee of Physi- 
cians, London; Professor of Medicine at the Victoria University ; 
Consulting Physician to the Manchester Royal Infirmary : 
Assisted by Robert Ma^ire, M. D., London ; Member of the 
Royal CoUe^ of Pbvsicians, London; Physician to Out-patients, 
Saint Mary's Hospital, London ; Late Pathologist to the Manches- 
ter Royal Infirmary.' Fourth edition; six hundred and twenty- 
eight pages. Philadelphia: Lea Brothers & Company, 1885. 

A SYSTEM OF PRACTICAL MEDICINE BY AMERICAN AUTH- 
ORS. Edited by William Pepper, M D., LLD„ Provost and Pro- 
fessor of the Theory and Practice of Medicine and of Clinical 
Medicine in ihe University of Pennsylvania; Assisted by Louis 
Starr, M. D., Clinical Profes;»or of Diseases of Children in the 
Hospital of the University of Pennsylvania. Volume II : Gren- 
eral Diseases (continued) and Diseases of the Digestive System. 
Contents of Volume II : Oeneral Di»ea9es — Rheumatism, dy R. 
Palmer Howard, M. D.; Gout, by W. H Draper, M. D.* Rachitis,, 
by Abraham Jacobi, M. D.; Scurvey, by Philip S. Wales, M. D.^ 
Ptirpura, by I. Edmonson Atkinson, M. D. ; Diabetes Mellitus, by 
James Tyson, A. M , M. D. : Scrofula, by John S. Lynch, M. D. ; 
Hereditary Syphilis, by J. William White, M. D.: Diseases of the 
Digesiive System — Diseases of the Mouth and Tongue, by J. Soils 
Cohen, M. D.; Diseases of the Tonsils, bv J. Solis Cohen, M. D. ; 
Diseases of the Pharynx, by J. Solis Cohen, M. D.; Diseases of 
the (Esophagus, by J. Solis Cohen, M. D. ; Functional and Inflam- 
matory Diseases of the Stomach, by Samuel G. Armour, M. D., 
LL. D.; Simple Ulcer of the Stomach by W H. Welch, M. D.; 
Haemorrhage from the Stomach, by W. H Welch, M. D.; Dila- 
tation of the Stomach, by W. H. Welch, M. D.; Minor Or^^nic 
Affections of the Stomach (Cirrhosis, Hypertrophic Stenosis of 
I^lorus, Atrophy, Anomalies in the Forms and in the Position 
of the Stomach, Rupture, Gastro-malacia), by W. H. Welch, M. D. ; 
Intestinal Indigestion, by W. W. Johnston, M. D ; Constipation, 
by W. W. Johnston, M. D. ; Entralgia (Intestinal Colic), by W. W. 
Johnston, M. D.- Acute Intestinal Catarrh (Duodenitis, Jejunitis, 
Ileitis^ Colitis, Proctitis), by W. W. Johnston, M. D. ; Chronic 
Intestinal Catarrh, by W. W. Johnston, M. D. ; Cholera Morbus^ 
by W. W. Johnston, M. D.; Intestinal Affections of Children in 
Hot Weather, by J, Lewis Smith, M. D.; Pseudo-Membranous- 
Enteritis, by Philip S. Wales, M. D.; Dysentery, by James T. 
Whittaker, A. M., M. D.; Typhi litis, Perityphilitis, and Paratyphil- 
itis, by James T. Whittaker, A. M., M. D.; Intestinal Ulcer, by 
James T. Whittaker, A, M., M. D. : Hsemorrhage of the Bowels, 
by James T. Whittaker, A. M., M. D.* Intestinal Obstruction, by 
Hunter McGuire, M. D. ; Cancer and Lardaceous Defeneration of 
the Intestines, by I Edmonson Atkinson, M. D. ; Disest^es of the 
Rectum and Anus, by Thomas G. Morton, M. D., and Henry M. 
Wetherill, Jr., M. G. Ph. G. ; Intestinal Worms, by Joseph Leidy^ 
M. D., LL. D. ; Diseases of the Liver, by Robert Bartholow, A. 
M., M. D.; Diseases of the Pincreas, by Lou.s Starrh, M. D.; Per- 
itonitis, by Alonzo Clark, M. D., LL. D. ; Diseases of the Abdom- 
inal Glands (Tabrs Mesenterica), by Samuel C. Busey,M. D. 



TREATMENT OP PULMONARY CONSUMPTION. 321 

MEDICAL DIGEST. 



RULES FOR THE HYGIENIC TREATMENT OF PULMONARY 

CONSUMPTION. 



Dr. Benjamin Ward Richardson writing in the Aaclepiad for 
April 1885, lays down ten rules for the hygienic treatment of 
pulmonary consumption, from which the following excerpt is 
made: 

Rule I. — A supply of pure air for respiration is the first indica- 
tion in the treatment of the consumptive patient. 

In large cities, and even in small towns, it is next to impos- 
sible to get a constant supply of pure air in inhabitated houses, 
for houses are built according to false notions of comfort. •** What 
a nice, cozy room I" is a common expression, applied inno- 
cently to every place where the greatest care has been taken to 
make an air- vault, without a "draught," and all ready for being 
charged with invisible impurities. 

In a cozy room the consumptive is bound never to live, nor, 
indeed, in anv one room for great lenghts of time. So long as 
he is able to be out of doors, ne is in his best and saff^st home. 
In the fields, on the hills, wherever the fresh air vivifies, where 
plants look most vigorous, and animals frisk about in the jov 
of health, there will the consumptive draw in his choicest med- 
icine, there meet most advantageously the dangers of his disease, 
and there repair most easily the waste of tissue. 

The inclemencies of the weather may temporarily, it is true, 
prevent the patient from his out-door existence. But even 
these inclemencies are not so much to be dreaded as confine- 
ment in a house. I have had occasion repeatedly to remark 
that if, from a few days' rain, the consumptives unaer my care 
were confined to their homes, instead of being able to take the 
daily out-door breathing invariably prescribed under such cir- 
cumstances, the aggravation of symptoms was always marked 
and universal. The appetite fell off, the debility became 

freater, the mind was less buoyant, the local mischief increased, 
'he patients, too, previously accustomed to a full dose of the 
air food, were not ignorant of the cause of these changes, for 
reduction in air is felt as quicklv as reduction in common diet. 
Seeing these evils, then, I nave long since thrown off the alarm 
about bad weather, and have ordered every patient to seize, 
even in an inclement day, each gleam of sunshme, for the pur- 
pose of getting out for a breath of fresh air. The result of this 
practice has been most gratifying in all cases where the courage 
of the patient has admitted of its application. 

As much of the day, then, as is possible, should be spent by 
the consumptive in the open air, and in places where the air is 
least impec^d and least corrupted. When he is compelled to 
u 



322 TREATMENT OF PULMONARY CONSUMPTION. 

keep the house, the necessary precautions must again be taken 
for procuring a free admission of the atmosphere. No cozy 
room with a temperature of 70°, with every crevice closed, and 
with an atmosphere in a dead calm and laden with impurities, 
should be permitted. But the temperature should be 60° 
Fahrenheit: the fire, if there be one, should be in an open 
grate ; and by a free chimney vent, secured by an Amott valve, 
the freest possible current of air should be kept circulating 
through the room. If the patient is cold, let him approach 
the fire, but let him not laoor under the popular and fatal 
error, that the way to obtain animal warmth is to shut Out the 
air and roast the body. The heat of the body is made in the 
body itself, by virtue mainly of the oxygen supplied in the air ; 
and as the body absorbs external heat with great difficulty, it 
would be as wise to attempt to give warmth by fires, hot bottles, 
and hot air, to a man who is not inhaling a due amount of 
oxygen, as to attempt the same process on a marble statue. In 
a word, external heat is useful only in preventing the too rapid 
radiation of animal heat from the surface of the animal body. 
Alone, it cannot supply heat; but when a wholesome air is 
inspired, it can secure the retention of the heat that is developed 
in the animal furnace. 

I spoke a moment ago of the open fire-grate. This is an 
essential for the room of the consumptive. Stoves of all kinds, 
heated pipes, and, in a word, all modes of supplying artificial 
warmth, except that by the radiation from an open fire, are, 
according to tne facts which I have been able to collect, inju- 
rious. They are injurious because by their means the air is 
made too dry, an objection much less applicable to the open fire. 

The bedroom should be large, unencumbered by needless 
furniture, and thoroughly ventilated. If the temperature of 
the air without is not below 60° Fahrenheit, the windows of 
the room should be boldly set open, and be kept open at the 
top all night. If they are to be closed of necessity, a free 
chimney draught must be procured. Warmth of body is best 
secured by woolen bedclothes • but if the temperature of the 
air is below 60°, it will, with aavantage, be raised to that pitch 
by a fire in the open grate. Gas should on no pretense be 
burned through the night in this bedroom, and as few other 
lights as possible, for the patient requires all the air that is to 
be had, and must not be carelessly robbed of it Above aU 
things^ tke consumptive person should be the sole occupant of hia oion 
bed and bedroom. To place eicch an one for several hours close to 
another person^ however healthy^ is injurious to both, but especially 
to' the sick. No ties of reUvHonship, and no mistaken kindness, should 
cause this rule of isolation ever to be broken. 

Rule II. — Active exercise is an essential dement in the treatment 
of consumptives. 

The conditions for obtaining a due supply of air imply in 



TREATMENT OF PULMONARY CONSUMPTION. 323 

some measure the necessity for exercise. But there are varieties 
of exercise. Drs. Rush, Jackson, and Parrish, are in favor of 
riding on horseback; but this is a thing not practically to be 
carried out in the majority of cases, and as I think, not abso- 
lutely necessary. Walking is the more natural exercise* it 
brings into movement every part of the body, more or less, 
and, leading to brisker circulation in every part, causes a more 
active nutrition generally. Of late years I have very much 
recommended tricycling to consumptive patients, and often 
with great benefit. In many instances it is better than walk- 
ing exercise, giving more perfect change of air and scene with 
less fatigue. 

If, in his waking hours, the consumptive patient can keep 
himself occupied pretty freely in muscular labor, he secures 
the best sudorfic for his sleeping hours that can possibly be 
supplied; for as the force of life is always expended in produc- 
ing motion or action, so, to use the words of Dr. Metcalfe, " the 
proximate cause of sleep is an expenditure of the substance and 
vital energy of the brain, nerves, and voluntary muscles, 
beyond what they receive when awake; and the specific office 
of sleep is the restoration of what has been wasted oy exercise." 
Cough is very much less frequent in the course of the night in 
him who has been subjected to exercise in the day; while sleep, 
when it falls, is more profound, more prolonged, and more 
refreshing. 

In summer time, when the temperature of the day is hish, 
the morning and the evening time are the best adapted for tne 
periods of out-door exertion. In the other seasons, mid-day is 
preferable, as a general rule. 

Rule III.— Jn vmform dimate is an important dement in the 
treaJtment of cansumptivea. 

Consumptive patients are constantly asking questions as to 
the value of a change of climate. The poorest applicants for 
relief are anxious on this point, and are often ready at once to 
contemplate emigration, if the merest hope is given to them 
that such a course would prove beneficial. In considering 
climate, the &ct should be remembered that the main point to 
be obtained is to select such a part of the earth's surface as 
presents the nearest approach to an equalitu of temperature. 
Difierent writers of eminence have given the most contrary 
opinions on cUmate and consumption. Some have recom- 
mended a warm climate, others the polar regions. 

I shall recommend no particular place as a resort for con- 
sumptives; for I wish not to enter into disputation on this 
point. But here is the formula for an hypothetical Atlantis 
for consumptives. It should be near the sea coast, and sheltered 
from easterly winds; the soil should be dry; the drinking 
water pure; the mean temperature about 60^, with a range of 
not more than ten or fifteen degrees on either side. It is not 



824 TREATMENT OF PULMONARY CONSUMPTION. 

easy to fix any decree of humidity ; but extremes of dryness or 
of moisture are alike injurious. It is of importance, in select- 
ing a locality, that the scenery should be enticing, so that the 
patient may be the more encouraged to spend his time out of 
doors, in walking or riding exercise. A town where the resi- 
dences are isolated and scattered about, and where drainage 
and cleanliness are attended to, is much preferable to one 
where the houses are closely packed, however small its popula- 
tion may be. 

Rule IV. — The dreaa of the consumptive patient should he adapted 
to equalize the temperature of the body, ana so loose that it interferes 
in no way with the animal functions. 

For the consumptive, flannel clothing is always required, 
and it should cover the whole of the body. The thickness of 
flannel must vary according to the sensations; as far as is 
possible, the feeling of absolute cold ought to be at all times 
prevented. The consumptive should sleep also in flannel ; not 
m the dress worn during the day, but in a flannel gown. The 
shoes worn should be lined with flannel. 

Rule V. — The hxmrs of rest of the consumptive paJdent should he 
regulated mainly by the absence of the sun. 

If exercise is important to the consumptive patient during 
the day, a due allowance of sleep is necessary during the night. 
The natural hours of sleep are from sunset to sunrise, and it is 
the business of the consumptive to make nature his oracle. 

Thus, to fulfill the natural law regulating the times of sleep, . 
to escape from the artificial light, and to obtain the advantage 
of all the sunlight that can be secured, the consumptive patient 
should make the sun his fellow workman. 

Rule VI. — The occupation of the consumptive patient should he 
suspended if it is in-door or sedentary; but a certain amount ofoutr 
door occupation rmxv be advantageous. 

This rule is often difficult to carry out. At the same time 
it is second to none in importance, as there is, in a word, no 
exciting cause of consumption so general as in-door occupation. 

I remember a patient once who, in the first stage of con- 
sumption, insisted on coming into town each morning, from a 
considerable distance in the country, to look after his business, 
and to return home again in the afternoon. It mattered not 
that the sky looked threatening, for he was not afraid of such a 
trifle, although he thoroughly knew his critical condition. 
When expostulated with by his advisers (and, I am ashamed 
to say, by myself, for I was ignorant then of the truths I now 
state), his reply was, "My brothers and sisters have all died of 
consumption; they were coddled up, nursed, carried about, 
confinea to bed, and bound in the cords of helplessness, by the 
kindest hands, to the satisfaction of the doctor and of all con- 
cerned. But they soon died. I inherit the proclivity to the 
same disease, and I too shall die; I know it; but my course is 



TREATMENT OF PULMONARY CONSUMPTION, 325 

differeDt, for I have made up my mind to die in harness ; I 
have kept at my business, in resistence to all entreaties, and I 
am the only oiie of the family left." The plan adopted by this 
man was right; he bore the brunt of the disease for months, 
and is alive and occupied still. 

Rule VII. — Excessive mental exertion ahovld be avoided by the 
cormmptive. 

I have seen so much mischief arise from the overwork of 
the mind, in consumptive children and youths, that I have 
dwelt no longer than is really necessary in treating on the 
importance of the present rule. If I had a child of decidedly 
consumptive tendency, he should scarely touch books at all. 
He should be taught orally as much as possible; he should be 
brought up in the open air, and to out-door pursuits and occu- 
pations; and he should be encouraged to enter into every 
mnocent game where the muscles are brought into vigorous 
play. 

Rule VIII. — Cleanliness of body is a special point in the treat- 
ment of consumption. 

But little need be said to enforce this rule. In health there 
is always a mutual understanding and a kind of partnership 
between the skin and lungs. In consumption moderate action 
of the skin is a relief to the lungs, and as such ought to be 
encouraged. This is best attained by keeping the skin clean 
by daily ablution. Let the consumptive boldly take his bath 
as each morning comes; not a shower bath, not a cold bath, 
under any impression that water cast on tha body in a certain 
fashion, or at a certain temperature, will give grtrength, but a 
tepid, cleansing bath, with the temperature from five to ten 
degrees below that of the body. There is no occasion to stay 
in the bath a moment longer than to obtain a free ablution; 
then the patient should rapidly but effectually dry himself all 
over with a rough towel, and dress with the flannel garment 
undermost. 

The clothes of the patient should be scrupulously clean; 
the under clothing should be changed every day. 

Rule IX. — Abstinence from all habits of gross sensual indulgence 
is an essential party both in the prevention and the cure of consumption, 

I need not particularize the vicious sensual indulgences to 
which many of human kind habituate themselves; for as sug- 
gestive descriptions are better left unwritten for those who are 
Ignorant of sensual indulgencies, so for them who require to be 
forwamed no such descriptions are demanded, since they know 
too much already. In a word, I should say that the grosser 
the senuality indulged in, the greater is the physical evil 
resulting from it. Let the consumptives, at least, bethink 
themselves what vicee affect and prostrate most, and then with 
strong mind and will give them up altogether. 

To those who have charge of the young, no duty is so imper- 



326 TREATMENT OF PULMONARY CONSUMPTION. 

alive as that of carefully watching over the physical interests. 
Let these make it their first care to prevent the tendency to 
sensual debasement. In large schools, a little attention and 
firmness on the part of teachers and governors, with the assist- 
ance of medical supervision, would obviate a host of life-long evils. 

Rule X. — T?ie diet of consumptive patients should be ampler 
and should contain a larger proportura of the respiratory constUr 
uents of food than is required in health. 

The quantity of food taken by the consumptive person 
should be small at each meal; but the meals mav, if the sensa- 
tions of the patient require it, be more frequent than in health. 
Of animal foods, mutton is the best. Fatty and oily foods^ 
which constitute the respiratory class, should predominate, ana 
fresh butter, with bread, may be taken almost ad libitum, so 
long as it agrees with the stomach. Cream, too, is excellent, 
and the luxury of curds and cream is very suitable. Milk, 
whenever it suits^ is advisable as a constant dnnk food, and good 
cows' milk, new, answers every purpose. There are, as far as I 
can gather from numerous cases in which I have seen them 
tried, no specific virtues in asses' milk and goats' milk as some 
have supposed. Tea may be taken, in moderation, with per- 
fect safety. Fresh vegetable diets should not be omitted ; and 
fruits, especially roasted apples, are always admissible, except 
in instances where they excite irregular action of the bowels. 
The Iceland moss has had a great reputation, as have jellies of 
difierent kinds, but these often are slow in digestion, and have 
no specific value. 

The question of the use of alcohol in consumption is one on 
which scientific opinion is much divided. I have recom- 
mended alcohol under some conditions of the disease, and I 
have shown, on the other hand, that one particular kind of 
consumption may be produced by indulgence in alcohol. Of 
late years I have prescribed alcohol very sparingly, and never 
in tlie form of pernicious mixtures in which it is sold for gen- 
eral use under the names and forms of alcoholic beverages. 
When I now prescribe it, it is purely as a medicine and in the 
form of alcohol itself, properly measured, properly diluted, and 
properly timed. In this form it comes unoer tne head of medic- 
inal, as distinguished from hygienic, treatment, and, I am 
satisfied, with much more value than when it is inaccurately 
classified as a food or drink. 

The two indulgences of snufiT-taking and tobacco-chewing, 
ought to be strictly avoided by the consumptive. 

Reviewing what has been thus written, I would add, as a 
supplement to the ten rules submitted, that whenever distinct 
evidences of phthisis have set in in an individual of either sex, 
the marriage of such person is wrong, if not inexcusable; while 
the marriage of two persons, both the victims to the disease, 10 
opposed both to reason and humanity. 



THE DOUCHE IN OBSTETRIC PRACTICE. 327 

Concluding Note. — The above essay "On the Hygienic 
Treatment of Pulmonary Consumption," less one or two minor 
revisions, was written and published under the same title in 
1856. 

The essay found little favor. It was considered as not 
practical, and as conveying the ideas of a dreamer, that the 
latal disease, consumption, could be prevented generally, and 
treated specially by hygienic measures. To-day, under a 
revival of the old animalcular speculation as to the origin of 
some diseases from living forms — the entity doctrine in a new 
dress — the conception of the hyjiiienic treatment of pulmonary 
consumption has been accepted in name as well as practice, as 
if it were new in word and deed, the height of practical learning 
and skill. So ideas change ; and the disfavored of one generation 
is the favored of another. But it matters not how or by whom 
it is borne, so long as the torchlight of truth makes its way. 



THE DOUCHE IN OBSTETRIC PRACTICE ; CLEANLINESS VER- 
SUS CONSERVATISM. 



The progressive obstetrician who has at heart the best inter- 
est of his patient and the advancement of his profession, like 
his progressive brother in other specialties, like the progressive 
man in life's struggle, must be prepared to battle with what is 
called conservatism. Guided by Knowledge and science he 
moves in advance of the mass who almost revile him, seeking 
eagerly for a possible defect in his method and, we regret to 
say, even unwilling to adopt such as prove successful and bene- 
ficial to mankind, until they have been universally and most 
unquestionably and undoubtedly adopted. 

Members of our profession labor in spheres often totally' 
difierent, and methods of treatment or suggestions advocated 
and successfully tested by one are wondered at and doubted by 
another. They live in different climes, among different people, 
or people of different habits, disposition and method of life; 
yaiying influences prevail. All this necessitates a variation of 
remedies, of method and practice. The differences which exist in 
the profession even in one and the same country are thus readily 
accounted for, and much of the strife would cease, and existing 
Tiews would be by (at more harmonious, if the disciples of the 
various beliefs would exchange their sphere of work. Views 
strange and peculiar to one not initiated into the peculiar sphere 
or work of the other may find much to criticise, frequently to 
ridicule. Could men stand upon the same platform and view the 
subject under discussion from the same point; were the work in 
the same sphere, these differences would be greatly dimished, 
though thev would not vanish on account of individual pecul- 
iarities. Thus the endless and vague discussions with regard 



828 THE DOUCHE IN OBSTETRIC PRACTICE. 

to the propriety and frequency of the use of the obstetric forceps 
would be greatly simplified, were the diciples of the various 
schools discussing the same subject. The country practitioner, 
especially in this western country, blessed with strong and 
healthy women, marvels at the figures presented to him by his 
confrere in the city witli an elegant clientele, practicing among 
delicate society ladies, and a university professor in charge or a 
consulting surgeon of a large lying-in hospital. The professor 
publishes an elaborate essay upon the use of the obstetric for- 
ceps ; he thinks it necessary to apply them in one out of every 
four or five cases, and gives a history of hundreds of such cases 
in the medial journals or at the meeting of the state or national 
association. 

The busy practitioner whose life has been devoted to the best 
interests of his profession in a small community, has seen a 
great many labor cases in his long eventful life, and claiming the 
experience of age, he violently assails the views presented by his 
colleague in the city. He has found it necessary to use the 
forceps but a few times, and, though he may not say so, he 
believes that his young friend, who makes these wonderful 
statements, is either stretching a little or* uses the obstetric 
forceps for the sake of eclat and, perhaps at times, to save him- 
self weary hours of watching, or that he may not lose a hot 
dinner. The views of both may be correct. The nervous, sen- 
sitive lady, whose evenings are spent in society, late to bed, 
with little or no exercise, her carriage or, at least the street car 
always at hand, cannot safely be permitted to undergo the suf- 
ferings of a tedious labor; she would succumb; though death 
might not result, she would be so completely prostrated that she 
might riot have sufficient force to expel the cnild after hours of 
futile suJBfering ; or if this should be accomplished, it is only done 
with a superhuman effort; then complete prostration follows. 
She must oe relieved. Why should she suffer? Whjr should 
every atom of strength be exhausted, if the obstetrician is at 
hand to relieve at the proper time and save her a vast amount 
of entirely needless suffering ? 

In the lying-in hospital the desperate cases are concentrated. 
Women who have before suffered in tedious labor go to the 
lying-in hospital, with the expectation of finding more skilled 
help, so also the woman who has been suffering for days in a 
prolonged labor finally comes to the lying-in hospital, when 
midwife or physician have failed in their attempts to turn or 
to extract with the forceps; hence it is that this man is 
obliged so often to use the instrument. The other, practicing 
in a community who lead a healthy out-door life, is dealing in 
the main with healthy women who do not mind a little suffer- 
ing; who have the muscle to expel the child and the nerve to 
bear it. He has no need of the instrument, and if in some 
cases he could save his patients some hours of needless 



THE DOUCHE IN OBSTETRIC PRACTICE. 329 

I 

fiuffering, he knows that his patient can give birth to the child 
without his aid, and a little more or less suffering will not make 
much difference; she will recover perfectly, though she may 
feel somewhat prostrated for a day or two ; moreover, his patient 
dreads the instrument. The patient of the other frequently 
demands it. She will not be permitted to suffer very long, thus 
he will frequently resort to the forceps when it may not be 
absolutely necessary ; yet no harm is done, and her strength is 
<5ertainly saved. Thus views differ. 

A great stride forward in obstetric practice which has of late 
been made consists in the use of the vaginal and intra-uterine 
douche in puerperal women. A great blessing, indeed. Not only 
a safeguard to prevent the possibility of infection, but a won- 
derful comfort to the patient, and, if properly given of a suffi- 
-cient temperature, an aid to involution. As the progressive 
physician makes this innovation in his obstetric practice, a hue 
And cry is raised of needless annoyance, of dangerous inter- 
ference. The intra-uterine injection must certainly be limited 
in its application, given with care, and under the proper condi- 
tions only, but it is a most valuable and effective method of 
treatment, which must be confined to its proper sphere. Of 
this we have nothing to say, but the antiseptic vaginal douche 
is agreeable and very beneficial. We do not wonder that oppo- 
sition is made, but we are astonished to have such opposition 
ooming from Boston, the great center of progress. Dr. Z. B. 
Adams, in the Boston MediccU and Surgical Journal, illustrates 
the danger of the practice and raises his warning voice. He 
«ays that it is medalesome, it is of doubtful utility, and it may 
be hurtful and even fatal. Let us see what he says : 

" I will cite an actual case, giving no names. A young woman 
in full and vigorous health, a fond and devoted wife, a mother 
for the first time, a proud and happy husband and father; this 
was the family. On the morning of the seventh day after 
delivery everything was going on perfectly well. The doctor 
considered the case finished. The wife had parted from her hus- 
band after breakfast, and he had gone in town to business, at 
her request, to stay until night. At 10 a. m. she sent him a 
telegram telling him not to come back at noon, she felt so per 
fectly well. This was the situation. Shortly after this tele- 
gram, the nurse who had, by direction of the phyt^ician, given 
the vaginal douche twice at least daily since confinement, pre- 
pared her syringe as usual. While the injection was flowing 
into the vagina the patient suddenly uttered a shriek, **OhI 
what pain! What have you done to me? I shall die! I shall 
die!" turned pale as death, gasped as if suffocated, her lips 
became livid, and she writhed in agony. This is the picture 
as given to me, soon after by one of the family. The doctor and 
husband were sent for, but she sank into unconsciousness, 
became convulsed, and was dead before evening. 



380 THE DOUCHE IN OBSTETRIC PRACTICE. 

** I have it from our lamented pathologist, Dr. Calvin Ellis, 
who was present at the autopsy, that air was found in the veins 
and heart. 

"There is no member of that family, and none of those 
who saw the case, who, as I believe, entertains a doubt that the 
use of the douche was the cause of death; the antiseptic 
douche, of which Dr. Thomas savs, ^That it can do no harm is 
quite evident.' The nurse, I understand, admits that she used 
more force than she intended to use. The doctor, a woman 
blames the nurse. This is ungenerous and irrational. The 
danger inheres in the practice itself. 

"Since I began the preparation of this paper, I have heard 
of a case in the practice of a neighboring physician, similar in 
many of its features to that just related, where, however, the 
final result was not reached until the fortieth day, the patient 
dying of septicaemia. The doctor, who did not see her at the 
time, says he does not know that the douche was the cause of 
death. Cases are known of collapse and shock following the 
use of the douche. 

"It is doubtless true that death is exceedingly rare from 
this practice. But yre do not hesitate to reject choloroform as- 
an ansesthetic on no better ground than this. So much for the 
danger. 

"I would thus sum up my objections to the septic douche- 
in midwifery. It is artificial, it is meddlesome; it is of doubt- i 
ful utility, and it may be hurtful and even fatal." ^ 

We should not have referred to the subject had it not come 
from such a source. It is, indeed, artificial, so is it meddle-^ 
some. All that the physician does is artificial and is an inter- 
ference with nature ; but a most beneficial one. It may save 
the patient from that dread puerperal fever; it may save her 
from death. It is so agreeable to every cleanly woman, that 
no lady who has once passed through a puerperium with the 
douche would go through another without it. I have invaria- 
bly heard expressions of delight from patients in whose con* 
finement I had assisted for the first time, if they have had an j 

opportunity for comparison. They are so much cleaner, sa 
much more comfortable, and, moreover, the lochia are dimin* 
ished. The room, bedding, patient is clean. We no longer 
recognize the odor of the puerperal room. In former days, 
according to the old method, the patient, without the douche^ 
was recognized as a puerperal at once upon entering the roomi. 
In extremely cleanly women the odor was still perceptible if 
liie bedaing was raised. If the antiseptic douche is used, this 
odor disappears and, moreover, as we have stated, this disagree* 
able lochial flow is greatly diminished, and why ? If it staff- 
nates in the vagina, a certain fermentation is inaugurated whiov I 
rapidly invades the uterine canal, and it is this fermentation 
which irritates the tissues, increases the flow, and produces the^ 



i 



THE DOUCHE IN OBSTETRIC PRACTICE. 331 

odor. Remove it constantly with an occassional intra-uterine 
injection ih addition, and you will have a nearly healthy 
lochial discharge which is slight and without odor. If but a 
trifle stagnates, we will have fermentation, and we all know 
how little of a ferment is needed to infect great quantities. 

Physician and patient cannot fail to be pleased with the 
agreeable and beneficial results of the vaginal douche in obstet- 
ric practice. The quantity of the flow is diminished, the char- 
acter improved. But our r/oston doctor says: "It may be 
hurtful and even fatal." Aye, everything that is beneficial 
may be hurtful, and I may add, the more oeneficial it is, the 
more hurtful it may prove, the more judiciously it must be 
used. Even so simple a remedy as the vaginal douche is itself 
dangerous. Years ago we called attention most earnestly to 
these dangers, but for that reason it should not be discarded. 
It should be used more judiciously. In a paper read before 
the Missouri State Medical Society, in 1S80, on the dangers 
incident to the simplest uterine manipulations and operations, 
we called attention to the fact that danger accompanies even 
the simplest manipulations, and that we should consequently 
exercise the utmost precaution even in those simple every-day 
maneuvers. 

We have cited serious and even fatal results following the 
use of the uterine sound, of simple applications to the uterine 
canal, even to the cervix; the dangers from scarifications, intra- 
uterine injections, and vaginal injections among others. We 
cited two cases which are striking, one, in our own practice, 
with intense pelvic pain and threatened peritonitis following 
the use of a Davidson syringe; another, followed by metro 
peritonitis and imperfect recovery, in the practice of Dr. Evans 
of Sedalia, Missouri, cases which, as we have stated, might 
unquestionably be tabulated again and again. But these will 
suffice to show, that even so simple a proceeding as the use 
of the vaginal douche is not wholly free from danger, and 
that it should be cautiously and judiciously employed. To 
obviate these dangers the patient should be careful : 

(1) To take the injection in the recumbent position, the hips 
rather higher than the head, the knees drawn up. 

(2) The nozzle of the syringe must not be permitted to 
touch the cervix ; hence it must not be introduced over an inch 
and a half to two inches into the vagina (the position assumed 
allows the water to flow back and thoroughly fill and distend 
the vagina). 

(3) A strong current must never be used whether bulb or 
fountain syringe is used. 

There is no doubt of the existence of such dangers, but they 
can readily be obviated by a little care; and, moreover, in this 
way the injection will be more serviceable and can be better 
given. We can but repeat that a certain danger accompanies 



332 DURATION OF LACTATION AND WEANING. 

the best and simplest remedies, and it is the duty of the physi- 
cian, when he orders such a remedy, to give specific' directions 
as to its use. We are glad that attention has again been called 
to these dangers. The vaginal injection in and out of the 
puerjperium is so freauently used that the physician should 
Dear it in mind and should caution his patients in the puer- 
perium of the dangers arising from the use of the douche as 

Eerhaps somewhat more than in the non-puerperal uterus. We 
ave used the antiseptic vaginal douche in the puerperium for 
several years. It has proved most beneficial, as has already 
been stated ; it is cleanly and agreeable to the patient ; lessens 
the discharge and does away with the disagreeable odor; more- 
over, it hastens involution, if used at a proper temperature. In 
the early days of the puerperium antiseptics should be added ; 
the bi-chloride, one to two thousand is preferable, having no 
odor as carbolic acid, and not staining the bed like perman- 
ganate of potash ; preferable to listerine, as it is inexpensive. 
In lying-in hospitals it is all the more important, as there the 
danger of infection is greatly increased. — Dr. Englemann in 
Saint Louis Weekly Medical Review. 



THE DURATION OF LACTATION AND WEANING. 



Parrot {JaJirb.f. Kinderh.^ Band XXI, Part III) recommends 
nursing mothers to begin to feed their children with some 
kind of milk preparation at least as soon as the sixth month, 
and if possible by the fifth or fourth. Those cases are excepted 
in which children are provided with good wet-nurses, when 
suckling may be continued to the eighth or tenth month with- 
out any other nutriment. It must be borne in mind, however, 
that such cases may require weaning suddenly, and the imme- 
diate adoption of artificial feeding mav be disastrous. As the 
child gets a little older (starting from the period at which arti- 
ficial feeding was begun), two additional meals of milk-pap 
may be given daily, and one of bouillon. The author thin^ 
that the period of nursing should be ended by the twelfth or 
fifteenth month, but this should never come in midsummer, 
rather at the end of spring or the beginning of fall. At the 
time of weaning, the child ought to be perfectly well, and 
should receive four meals daily, twice of milk-soup, or milk pap 
containing arrow-root, rice, or barley-flour, and twice of meat 
soup with tapioca, or other suitable ingredients. Between meals 
plenty of good cow's milk should be drunk. At a later period 
the author recommends, as readily digestible, a soup composed 
of meat juice, bits of white bread, and yolk of egg, with a suit- 
able quantity of water. In addition to wat^r, for drinking, the 
author thinks that a little Bordeaux wine or cognac is often 
appropriate. Easily assimilated mineral waters may also be 
given in small quantities. — Archives of Pediatrics, 



TYPHOID FEVER — PREMATURE LABOR. 333 

ANTIPYRINE IN TYPHOID FEVER. 



Dr. J. E. Newcomb gives, in the Weekly Medical Review, an 
account of the use of antipyrine in eight cases of typhoid fever 
at the Roosevelt Hospital, New York. The conclusions he 
draws are as follows: 

(1) We have in antipyrine a remedy which will reduce tem- 
perature quickly and decidedly. After a dose of thirty grains 
the fall msLV amount to four degrees in as many hours; the 
effect lasts from four to twenty-four hours. 

(2) The pulse and respiration are practically unaffected, 
except in some cases the vascular tension is increased. 

(o) Sweating generally follows the administration of the 
remedy. It is sometimes profuse, but does not seem to weaken 
the patient or render him uncomfortable. The sweat itself has 
no peculiar physical properties. 

(4) An eruption is sometimes noticed. Its nature is ery- 
thematous. Rarely does desquamation follow. 

(5) Antipyrine does not in any way rival quinine as an 
antiperiodic or tonic. 

(6) It must be used carefully in depressed states. Untoward 
effects have resulted from its use. 

(7) It is easily administered and generally retained. It is 
about fifty per cent, more expensive than quinine. 

In regard to its future influence on mortality in disease we 
can do no better than to quote the words of Rank. * He says: 
" We hope that the fanatic of antipyresis, who wages the onset 
a^inst this one symptom, will finally be brought to the con- 
clusion that therapy has a far weightier task than the produc- 
tion of infractions as deep as possible in the temperature curve. 
Whether the antipyrine treatment is in a position to lessen the 
dangers which threaten fever patients can scarcely be answered 
as long as we do not know how far the symptom (the subjection 
of which this method of treatment arrives at) is on the whole 
of deadly influence on the sy&tem" ^LouisviUe Medical News. 



PREMATURE LABOR. 



Dr. Clarke, of Cambridge, Massachusetts, reports two cases, 
and writes as follows concerning the methods or performing the 
operation : The plan of inducing premature labor by the intro- 
duction of a flexible gum elastic bougie, is evidently a safe and 
easy method. My experience in the use of sponge tents, even 
when thoroughly carbolized, for dilating the cervix for any pur- 
pose whatever, is unsafe and often leads to irreparable mis- 
chief. For a long time I have abandoned their use altogether. 
The use of a flexible gum elastic bougie is more scientific. The 
bougie is cleanlv; its presence in the uterine cavity, across the 
fiindus, after a few hours, will often excite healthy and normal 



334 PREMATURE LABOR — MISCELLANEOUS ITEMS. 

uterine contractions. In any case where any unpleasant or any 
constitutional disturbances arise from its presence, it can be 
readily removed by the attendant, or the patient herself, before 
alarming or serious symptoms supervene The bougie is also 
applicable in cases in which it is desirable to induce abortion 
for the relief of obstinate vomiting of pregnancy, that some- 
times threatens the life of the patient. 1 have used it for such 
a purpose, and have found it a most valuable means of empty- 
ing the uterus of its contents. Digital dilatation, when care- 
fully and judiciously practiced, is also a most valuable means 
in any case where the emptying of the uterus is urgently and 
speedily demanded. 

An important consideration in a case where the induction of 
premature labor is required is, to ascertain when the time has 
arrived beyond which pregn&ncy should not continue. This 
can only be decided by careful consideration of the whole his- 
torv of the case. From my experience in the above cases, as 
well as from my general obstetric practice, I would state that 
in no case should the induction of premature labor be under- 
taken until a most thorough study or knowledge has been gained 
of a previous pregnancy, or pregnancies, for it is absolutely 
impossible to obtain any definite and reliable knowledge rela- 
tive to the dimensions of the pelvis until labor is well advanced 
or immediately after it has been completed. — Medical Times. 

MISCELLANEOUS ITEMS. 



Cold in Sciatica — Dr. Debove often obtains rapid cures of 
sciatica by applying a spray of chloride of methyl along the 
course of the nerve. This will reduce the temperature to 20** 
below zero Fahrenheit. — London Medical Times. 



Lubricant for Catheters.— Eighteen grains of boracic acid, 
dissolved in a drachm of hot glycerine, and added to an ounce 
of olive oil make an excellent lubricant for catheters and bou- 
gies: it is stable, antiseptic unirritating. — Texas Courier-Record, 

Ergot for Dysentery in Children. — Twenty-one cases 
of dysentery in children, reported by Dr. Q. I. Magruder ( Vir- 
ginia Medical MonMy)^ were treated with fluid extract of ereot, 
five to twenty drops four or five times a day. All were either 
entirely relieved or much improved. 

Permanganate of Potassium in Amenorrhcea. — Dr. A. H. 
Bampton, writing to the British Medical Journal, recommends 
unguentum resinse as a convenient and suitable excipient for 
permanganate of potassium when ordered in pill form, whilst 
kaolin is difficult to manipulate and of a stony hardness when 
made up and dried. 



MISCELLANEOUS ITEMS. 335 

To Abort Sick Headache. — Dr. W. G. Wylie says that he 
always shortens, and sometimes entirely aborts, sick headache, 
by the following plan: As soon as the first pain is felt the 
patient takes a capsule containing one grain of inspissated 
ox-gall and one drop of oil of gaultheria, and repeats the dose 
every hour, until relief, or until six have been taken. — Detroit 
Lancet 



Injection for Vaginal Leucorrhcea. — Take of powdered 
hydrastis root, ten grains, and to it four ounces of hot water. 
Let it steep twenty minutes. Cool, strain, and use as an injec- 
tion morning and night. Also, make a vaginal examination 
and spray the vaginal surface with Churchill's tincture of 
iodine or extract of pinus canadensis. — New England Medical 
Monthly. 

A Lotion for P(etid Perspiration of the Feet. — Martin 
{BvU. gen, de Therap,) recommends the following solution : 

PermaDganate of potasBium 15 grains. 

Thymol 90 grains. 

Distilled water..» 30 ounces. 

Inner soles made of filtering paper, cotton, or some like 
material, are to be moistened with the solution, and new ones 
should be used every morning. 

The Combined Administration of Belladonna and Iodide 
OF Potassium. — Aubert affirms that the headache and coryza 
experienced after taking large doses of iodide of potassium 
may be entirely prevented by the judicious use of belladonna. 
In the case reported eighty grains of iodide were given dailjy, 
one grain of tne extract of belladonna being administered in 
the evening. After a few days, the writer states, it is possible 
to suspend the use of the latter drug without any danger of a 
recurrence of the iodism. — New York Medical Journal. 



Micrococci of Pneumonia Associated with Scarlet Fever 
AND Dyphtheria — Dr. Lumbrosa concludes, from the exami- 
nation of four cases, and culture experiments, that the micro- 
coccus found in broncho-pneumonia occurring in scarlet fever, 
diphtheria, and croup, although identical in form with that of 
true pneumonia, is not biologically the same. He has never 
been able to reproduce the disease from the pure culture. He 
believes that in infectious diseases the pneumonia coccus has 
altered proportions. — Le Progres Meddcal. — Medical Record. 

Cannabis Indica as a Local Anjbsthetig. — A. Aaronson 
writes in the British Journal of Dental Science that tincture of 
cannabis indica as a local ansesthetic is perfectly satisfactory. 
He has extracted with its aid, as many as twenty- two teeth 



336 MISCELLANEOUS ITEMS. 

and stumps at one sitting. His plan is to dilute the tincture 
some three to five times, according to the probable duration of 
the operation. The diluted tincture is then applied in cotton- 
wool to cavities, if such exist, and also about tne gums of the 
affected teeth. The beaks of the extracting-forceps are, also, 
after being warmed, dipped in the diluted tincture. 

Buckwheat Flour in Diabetes. — Dr. A. M. Duncan, of 
Hamler, Ohio, writes that Dr. Alvord, a retired practitioner of 
that place, who is a sufferer from glycosuria, finds more relief 
from a diet of pure buckwheat flour cakes than from anything 
else. While he adheres to this food the urine becomes nearly 
normal in quantity and quality, there is no gastric distress, 
and the pain in the eyes — nearly destroyed by chronic iritis — 
is markedly relieved. On resuming the use of wheat bread 
and other starchy foods, the symptoms become aggravated, to 
be again relieved upon a return to buckwheat.— ^Jl^tcoZ Record. 

Dr. Weathers, of San Antonio, states : " From the char- 
acter of the formula, I observe that tongaline is a combination 
of such agents as my experience suggests to be very valuable, 
and is therefore deserving of great praise. I find it a splendid 
remedy not only for those complaints for which it is recom- 
mended, such as neuralgia, rheumatism, and nervous head- 
ache in their various forms, but have also done good work 
with it in pneumonia and fevers, especially when the latter 
arise from malarial causes. Combined with a small quantity 
of aconite, I have found there is nothing better to equalize 
thoroughly the circulation and produce firee diaphoresis. 
When followed by a few doses of quinine the results have been 
remarkably successful. All who try tongaline will be con- 
strained to acknowledge its virtues. 

Acute Dysentery. — Professor DaCosta says the best treat- 
ment is ipecacuanha, not to exceed twenty grains, every two 
or three hours, guarded with opium, and ne has very marked 
results from this plan. It is especially good in puerperal 
dysentery, as Professor Bartholow has pointed out. The 
opium plan (one-half grain every two hours) is good. Next 
is Rochelle salts, one ounce in divided doses in the first 
twenty-four hours and less thereafter. This does not preclude 
the simultaneous use of small doses of opium. Both the 
ipecacuanha and the saline purgative plans should be aban- 
aoned in two days, if no change in the condition of the 

Satient, is seen; they are rapid or valueless in their action, 
fext comes bismuth subnitrate, ten to twenty grains every two 
or three hours. The use of ice water injections three or four 
times a day was originated by him some years ago. They are 
very valuable. Sinapisms and blisters are useless. 



THU 



PBYSICIAI AND SUEGEOS 

A MONTHLY MAGAZINE. 
DEVOTED TO MEDICAL AND SURGICAL SCIENCE. 



Volume VII. AUGUST, 1885. Number VIII. 



ORIGINAL ARTICLES. 



THE TREATMENT OF HYDROCELE. 



BY T. J. SULLIVAN, M. D,, Amm Ajibob, Michigan. 



It is somewhat surprising to find detailed in the medical 
journals of the day, numerous new plans for the treatment of 
hydrocele, or various modifications of old methods which 
should have been discarded years ago. A leadins journal, 
published a short time ago, an abstract of an article on the 
antiseptic incision for the treatment of hydrocele, and in com- 
menting on the operation raised the question : " Why resort to 
such a slow and dangerous procedure; when the injection of a 
solution of carbolic acid is much safer ? " The same question 
may be asked regarding the use of carbolic acid, wnen we 
have, without incurring any risk or danger, the satisfjEictory 
results obtained by the use of tincture of iodine. 

The treatment by injection of tincture of iodine was first 
employed by a surgeon in the Scotch army named Munroe, in 
the early part of the last century. Sir J. R. Martin is also 
credited as being the first to introduce this plan of treatment, 
while practicing in Calcutta, and reports but one per cent, of 
failures. Opinions difier regarding the manner which iodine 
efiects a cure. It is thought by some that the sac is closed by 
adhesive infiammation. Others maintain that there is no 
closure, but, that the secreting surface is altered in character 
so as to prevent any subsequent efi'usion, or changed to its nat- 
ural healthy state. In recent cases and those of small size the 



3^ TMe f REATiiENT Of HYl)tlOCEtt!. 

first opinion is probably correct, while in cases of long stand- 
ing, and large accumulations, both processes operate. 

The instruments necessary for the successful performance 
of the injection of iodine, are a moderate sized trocar and can- 
ula ahd a two drachm hard-rubber syringe to accurately fit the 
canula. The details of the operation are as follows : The tro- 
car having been first dipped in oil to facilitate its passage, is 
introduced at the most prominent part of the hydrocele, the 
left hand at the same time firmly grasping the posterior por- 
tion of the scrotum. The trocar is easily and more safely 
introduced by a gentle, steady pressure, the left hand furnish- 
ing a firm support from behind. Before changing the direction 
of the instrument the trocar is withdrawn, the canula is then 
turned slightly upward, and the tumor is compressed until 
every possible drop of the fluid is evacuated. Next the syr- 
inge, filled with the tincture of iodine (United States Pharma- 
copoeia), is fitted in the canula, and its contents thrown into 
the cavity. The tissues' of the scrotum around the canula 
should then be clasped with the thumb and forefinger of the 
right hand and the canula withdrawn rapidly, in order to pre- 
vent the escape of the iodine externally or into the loose sub- 
cutaneous cellular tissue. While maintaining this clasp of the 
tissues, the scrotum should be shaken vigorously and thor- 
oughly, to bring the iodine in contact with every part of the 
secreting surface. The patient should always be standing when 
the operation is done, this position greatly facilitating its per- 
formance. If the above details are carried out, the operation 
will be almost painless and will result in a perpaanent cure. 

In a case with a very large hydrocele it may be necessary to 
inject more than two drachms of the tincture to produce the 
requisite amount of irritation and inflammation; while in 
children the mere withdrawal of the fluid, as a rule, is all that 
is necessary to prevent further secretion. 

Failure to make a radical cure, sloughing of the scrotum, 
and other unfortunate results, are due to faults in the methods 
of the operation, or to some improper use of the iodine. 
Thousanas of cases have been reported and are on record, in 
which the tincture of iodine, in its full strength, has been used 
in the way described without any bad results, and every case 
terminating in a perfect cure. It is a safe assertion to make, 
that when the tincture of iodine fails to produce a cure or 
when it causes sloughing, the surgeon is at fault and not the 
plan of treatment. Agnew states the case fairly when he says 
the "discrepancy of views in regard to this simple measure of 
injection in hydrocele lies not in the method but in the manner 
of its execution." 

Erichsen, in the last edition of his "Science and Art of Sur- 
gery," speaking of the injection of iodine for the cure of hydro- 
cele, says: "It may be used pure or diluted with an equal 



^ 



0A8B oi^ Actrns cYsftaiB, 839 

Quantity of water. After injection the surgeon should rub the 
scrotum gently over the testes, so as to diffuse the injection 
equally over the surface of the sac. One-half the quantity 
thrown in should then be allowed to escape, the canula removea 
and the parts dressed with a piece of plaster. Useful as the 
iodine injection is, it sometimes fails in producing a radical 
cure of hydrocele." 

In all the cases reported in which there was a failure to pro- 
duce a cure the iodine was used diluted or allowed to escape 
through the canula. On the other hand, where sloughing of 
the scrotum and other bad results followed, there was too large 
a quantity of iodine used, or it escaped into the cellular tissue 
during the withdrawal of the canula. A case came under my 
observation, where the entire scrotum sloughed, after the injec- 
tion of four ounces of the strong tincture. There are many 
other such unreasonable modes of using the iodine. Erichsen's 
method of using the iodine fails to produce a radical cure, in 
some cases, for the following . reasons : First, the iodine is 
diluted ; second, one-half the quantity injected is allowed to 
escape ; third the agitation of the scrotum is' too gentle. 

In conclusion the important points in this plan of treatment 
can be summarized as follows: First, evacuate every possible 
drop of the fluid ; second, inject two drachms of the. tincture of 
iodme (United States PharmacopoBia): third, remove the canula 
without allowing any of the iodine to escape externally or into 
the cellular tissue; fourth, shake the scrotum thoroughly, so as 
to bring the injection in contact with every part of the sac wall. 



CASE OF ACUTE CYSTITIS: TREATMENT; MICRO-ORGANISMS. 



BY JOHN W. HANDY, M. D.. Habtland, Michigan. 



The following case may present some features of interest if 
many common ones. It being a long one, only a somewhat 
lengthy "brief" will be given. 

On Friday, January 30, 1 was called to see Mrs. G., married 
lady ; aged twenty-seven ; never has borne children. Has mitral 
insufficiency, but otherwise is healthy. Patient complained of 
pain with micturition, with frequent desire for evacuation of 
bladder, and large discharge of mucus. 

I ordered plenty of water to be drank. Infusion of buchu, 
and light exercise, with no improper exposure. On Sunday she 
expressed herself as " well." This day she moved about consider- 
able entertaining guests, and attended divine services at night. 
On retiring she felt some of the difficulty. Monday, did some 
washing and caught cold. Now began to appear large quanti- 
ties of pus in the urine. Pain severe ; could not move about 
much, yet could not readily be pursuaded to keep the bed. 



840 (jASic oi* Acu1*fe cvsmis. 

Treatment continued with hot sitz baths and douches. Wednes- 
day evening a large party gathered at the house. With much 
effort she kept up. W as forced to evacuate the bladder once in 
about every twenty minutes. As the house was thronged, she 
was forced to go to a cold privy. This continued until about 
2 A. H., Thursday, when she retired nearly exhausted. 

Now began what proved to be a severe illness for about three 
months. 

The urine now became sharply acid and very scant. Baths 
and douches were continued, which would rebeve pain for a 
short time. Buchu, uva ursi, pareira, etc., were used with 
alkalies, with but little effect on the amount of urine. Digitalis 
and acetate of potassium were used with an increase of urine 
having an alkaloid reaction. Digitalis was now slowly left off 
and potassium continued. The bowels were moved by enemas 
and anodynes used pro re nata. The anodynes found most 
satisfactory were morphia sulphate, and atropia sulphate, one- 
fourth gram of former to one-hundred-and-fiftieth gram of latter, 
used by podermically. At times severe pricking sensations attack 
the region of the genital organs. Hot fomentations combined 
with local anodynes were used with varying success. On the 
least exposure these pricking sensations would change into 
neuralgic pains, radiating upwards, anteriorly, into the pectoral 
region, posteriorly, not so high, but at no time extending to the 
region of the kidney. At times, the severity of these pains 
produced spasms nearly rising in rank to convulsions, produc- 
ing semi-unconsciousness. Morphia and atropia in large doses 
hypodermically, and hot fomentations were used to control 
them. Now, February 19, the disease has fluctuated much. 
At times the urine is clear and the act painless, at other times 
the reverse. When clear and painless patient felt well. (This 
is copied from notebook). 

Local and systemic treatment was now resorted to, and 
recognizing a possible bacterial element, although finding no 
germs with the higher objectives, bichloride of mercury was 
employed as a wash tri-weekly, one part to one thousand and 
two thousand, but no good results followed. Haemorrhage 
from above the bladder wr three days gave its peculiar smoky 
color to the urine, but at no time could the least tenderness be 
discovered in the region of the kidney. After ten days' trial of 
the germicide (for this and a possible alterative effect upon the 
surface of the inflamed organ), it was supplanted with nitrate 
of silver, one to five grains to the ounce, or as strong as the 
patient seemed able to bear, followed by a weak solution of 
sodium chloride. Washings were preceded by hypodermics to 
allay irritation as the urethra was exceedingly irritable, allow- 
ing only one of the smallest gum catheters to be used. Irriga- 
tion was tried with double channeled catheter but the urethra 
would not allow passage of it. Urine was repeatedly examined 



CASK OF ACUTE CYSTITIS. 341 

under the high power, immediately on its passage. The germ- 
icide was occasionally alternated with the silver, and a steady 
course was kept up of tonics, diuretics (alkaline), hot baths and 
douches, enemas or very gentle laxatives, with absolute rest in 
a warm room for seven weeks, with alternating flattering suc- 
cesses and absolute failures. 

Patient was slowly gaining and sitting up. She now ran 
out of the alkaline diuretic and orders to immediately renew it 
being neglected for a time, the patient was found suffering froi^i 
acid urine, and severe consequent urethral spasm and retention. 
Urine was immediately drawn and the bladder washed out with 
a weak alkaline solution of bicarbonate of soda in milk and a 
little water, with perfect relief. The following morning the urine 
presented a fetid odor besides that peculiar to the soda, like 
biscuits made with a surplus of this chemical. This was the first 
time a fetid odor had been noticed. The urine now became 
rapidly bloody and loaded with pus. Pain on micturition 
excessively severe; the patient failing to completely empty the 
bladder because of severe irritation produced by contact of 
collapsed walls. To this was soon adaed urethral spasm and 
greater retention ; to the latter I ascribed for a time the decom- 
position. When daily washings, with the urine alkaline in 
reaction, did not diminish the fetid odor, which had increased 
until it was almost unbearable, charging the air of the room, 
other measures were sought The fresnly passed urine was 
again subjected to examination under high power, and this 
time found teeming with micro-organisms. The irritation was 
now more severe than at any other time. The germicide was 
again immediately resorted to, one part to me thousand. 
Patient was much irritated by the washing (she having deter- 
mined to do without the hypodermics of morphia and atropia), 
and on account of severe spasmodic contractions, part of the 
fluid had to be left in the viscus bringing on increased con- 
tractions of the organ, yet retaining the fluid, as the urethra 
closed forcibly. An anodyne soon allayed excitement and in a 
short time the bladder was quite easily emptied. 

The following morning no offensive odor could be detected 
in the urine. It rapidly cleared of blood and in two days the 

1)atient was up and went on quickly to recovery, with no more 
ocal treatment, — neither could any more micro-organisms be 
found. 

During the entire time any cool change in weather or slight 
draught of air was followed by a relapse of symptoms, and six 
of such changes occurred. 

At ho time during the entire period of illness could any bac- 
teria be detected, or odor peculiar thereto, until after the alka- 
line washing with milk. When washed with water it was 
obtained at sJl times from same place and boiled before using. 
Did bacteria enter with the milk? 



342 UPS AND DOWNS OF THB PEACmTtONEB. 

THE "UPS AND DOWNS" OF THE ORDINARY PRACTITIONER.* 



BY F. J. GRONER, M. D., Big Rapiiib, Michiqan. 



I thank vou kindly for the honor you have conferred upon 
me. It shall be my utmost endeavor to fill this office as faith- 
fully as has been done by my predecessors. 

Our society is now entering upon its tenth year of continu- 
ous existence, excepting a slight period in 1880 and 1881. The 
period of my connection with this society has been one of 
pleasure and profit. The interchange of ideas and contact of 
mind with mmd has been a stimulus for harder study and 
deeper research. Some valuable papers and suggestions have 
emanated from this society and found place in the medical liter- 
ature of the day. Our membership is constantly enlarging, but 
this should not interfere with a free, liberal and amicable dis- 
cussion of any subiect that may come before the society. For, 
under no other relation can each contribute so much to the 
instruction and intellectual recreation of himself and others as 
in face to face discussion. Here we can study the difibrent 
methods of other physicians and learn the secrets of their suc- 
cesses or failures. Instead of a day's loss from business and 
the expenditure of a few dollars by attending a meeting, we 
have a gain that cannot be measured by dollars and cents. 

It is customary for the president of a medical society in his 
address to give a review of the advances in some particular 
field of medicine or surgery, or what is too often done, give the 
whole history of medicine and surgery. But to-day, instead of 
taking the whole review of "bacterio-mania," or the depths of 
laparotomy, let us look at some of the ups and dofvns of the 
ordinary practitioner. For every practitioner knows, or if he 
does not, he will soon find out, that it is not only bacteria and 
other micro-organisms he has to deal with, but men and women, 
especially "oW wonien.^^ The question very naturally arises, 
''How can a physician best gain and maintain a portion of the 
public confidence, so that there is no worry about money to 
meet current expenses? " There is nothing that so quickly sets 
the tongue of scandal wagging against a physician as a con- 
stant debit in his accounts for his necessities or luxuries in 
life. This is an old subject, but there is not always as much 
to be learned from new theories as from old truths oft repeated. 
It is not diseases alone that we are called upon to treat, but 
more often individuals. And however intelligent a community 
may be with respect to politics, literature, art and other sub- 
jects, it is hopelessly ignorant in regard to our science; or if a 
few possess some knowledge on the subject, it is the "little 
knowledge" that "is a dangerous thing." Mr. Huxley speaks 

*The address of the President of the Union Medical Society of 
Northern Michigan : published in abstract 



UPS AND DOWNS OF THE PRACTITIONER. 343 

of the utter ignorance in his own countrymen of the simplest 
laws of their own animal life. Dr. GuUen said he was obliged 
to please his patients sometimes with reasons, and found that 
any would pass, even with able divines and acute lawyers; the 
same would pass with the husbands as with the wives. But 
some one has said that vou must hold medicine as a great 
mystery, for the doctor wno is weak enough to eTmlain anvtning 
to a patient is supposed to know very litue. The people can- 
not ie made awal^i^of their utter ignorance, and incompetency 
to form opinions on medical subjects. Those, even, wno give 
their lives to the study find always perplexing problems and 
difiicult tasks. But the masses will form opinions however 
slight and deceptive the foundation. Every "old woman" (no 
disrespect at all is intended for the kind old ladies; you all 
have met them ; they are everywhere, but are not accountable 
for their unbalanced judgments), I say every "old woman" 
has been sick or had some friend ill who has recovered from 
just such illness as you are treating, and as the last pill or 
potion is what cured the patient, good mother "so and so" has 
Mrs. Lydia Pinkham's compound, or her own favored doctor's 
remedy, or the doctor himself to offer. And thus the doctor 
often finds that instead of his own specific directions being 
carried out, others have been substituted. This is only one of 
the unpleasant things a doctor meets and has to overcome. 
"All is not gold that glitters." I will give some of the sweets 
of a doctor's life from the Hebrew StancUird: 

"If he visits a few of his patients when they are well, it is to 
get his dinner; and if he does not do so, it is because ne cares 
more for the fleece than the flock. If he goes to synagogue 
regularly, it is because he has nothing else to do ; and if he 
does not go, it is because he has no respect for the Sabbath nor 
religion. If he speaks reverently of Judaism, he is a hypo- 
crite; if he does not, he is a materialist. If he dresses neatiiy. 
he is proud; if he does not, he is wanting in self-respect. It 
his wife does not call, she is 'stuck up;' if she does, she is fish- 
ing for patients for her husband. If he has a good turnout, he 
is extravagant; if he uses a poor one on the score of economy, 
he is deficient in necessary pride. If he does not write a pre- 
scription for every trifling ailment, he is careless; if he does, he 
deluges one with medicine. If he gives entertainments, it is to 
bait the people to get their monev; if he does not give them, 
he is afraid of spending a cent. Ii his horse is fat, it is because 
he has nothing to do; if he is lean, it is because he is not taken 
care of. If he drives fast, it is to make people believe some- 
body is very sick; if he drives slowly, he has no interest in the 
welfare of his patients. If the patient recovers, it is owing to 
the good nursing he received ; if he dies, the doctor did not 
understand his sickness. If he talks much, we do not like a 
doctor to tell everything he knows, or, he is altogether too 



344 UPS AND DOWNS OF THE PRACTITIONEB. 

familiar; if he does not talk, we like to see a doctor sociable. 
If he says anything about politics, he had better let it alone ; 
if he does not say anything about it, we like to see a man show 
his colors. If he does not come immediately when sent for, he 
takes things too easy ; if he sends his bill, he is in a terrible 
hurry foD his money. If he visits his patients every day, it is 
to run up a bill; if he does not, it is unjustifiable negligence. 
If he continues the same medicine, it does no good; if he 
changes the prescription, he is in league with the druggist. If 
he uses any of the popular remedies of the day, it is to cater 
to the whims and prejudice of the people, to fill his pockets ; 
if he does not use them, it is from professional prejudices. It 
he is in the habit of having frequent consultations, it is because 
he knows nothing; if he ODJects to having them, on the ground 
that he understands his own business, he is afraid of exposing 
his ignorance. If he gets pay for onerhalf his services he deserves 
to be canonized. Who would not be an M. D.?" 

Who among you has not listened for a whole two hours, 
when you were very busy, to some old lady's delineation of 
^*all the ills that flesh is heir to,'' and get the final admonition 
that " Now, doctor, I want you to study my liver," and after 
giving a little pepsin have the same old lady call sixteen times 
at your office, and attempt to follow you all over town, and 
finally find you as you return from a long drive and exclaim, 
" Doctor, what efiect did you expect from that medicine ? I 
am worse to-day than ever before I" Or who has not 

** Shunned delights, 
And lived laborioos days "— 

and nights, and taxed your utmost strength and ability over 
one whom the savage hand of the destroyer is stronger than 
J;he remedies nature has furnished ; and after the long, fearful, 
l^nal struggle, in spile of all your faithful, patient, earnest labor, 
you find the tongue of scandal blasting your reputation, and 
your honorable conduct grossly maligned. Persons who will 
swear by you one week will curse you the next, and declare 
you have killed their children or crippled them for life. Peo- 
ple soon forget that all must die ; and that doctors do not hold 
the key of life. Trifles light as air will break links that you 
thought never could be broken. How true the poet's picture 
in the Oov/ntry Doctor : 

"When coveted success had eased his brain, 

He oft could feel the force of the refrain — 
' Three faces wears the doctor; when first sought 

An angel's ; and a God's the case half wrought ; 

But when, the cure complete, he seeks his fee, 

The devil is less terrible than he.' 

'Twas his to know betimes when he had done 

Most faithful service, he had scarce begun 

Rejoicing ere the shaft of malice dread. 

Like hailstones fell on his devoted head." 



i 



UPS AMD DOWNS OF THE PRACTITIONER. 345 

These are but a very few of the trials and vexations that 
every practitioner meets. But these do not answer the ques- 
tion of a doctor's success. The very first essential is to deserve 
it. And by this I mean a thorough medical education and 
an entire devotion to the profession. The Hippocratic oath 
bound the physician to enter the patient's house only for the 
the patient s good — and to pass his life and practice his art with 
purity and holiness. No other person so much needs all the 
virtues and graces to insure success as the physician. 

Sir 7ames Paget has shown that out of one thousand medical 
students, twenty-three had achieved distinguished success, sixty- 
nine had achieved what might be called considerable success, 
and five hundred and seven had achieved fair success. That 
he reckoned to be a larger proportion than any other of the 
higher professions could boast. The opinion of Sir James Paget 
in reference to the medical profession is, that as a man began so 
he continued, and so he ended. 

Medicine is the most difiicult of sciences and the most labo- 
rious of arts. In order to make a successful practitioner it is nec- 
essary to put forth the best powers of both oody and mind. It 
is true that some great minds have accomplished work outside 
of the profession — such men as Virchow, Sir Thomas Watson, 
Sir Henry Thompson, Dr. Richardson, Benjamin Rush, Oliver 
Wendell Homes, Dr. Hammond and others. But the great 
practioners are the ones who concentrate their entire powers on 
their business. 

It is not necessary for me to mention the numerous elements 
necessary to success. You will, however, find that a great many 
who worry so much about the over-crowded condition of the 
profession are those who have not bought a new book since 
receiving their diplomas; and some have not taken time to^ 
re-read an old one. Many of these never succeed,; the few 
who do have the particular composition of Bangs. (See Medical 
Record^ Volume XXIV, page 166). A mechanic might as well 
think of succeeding without proper tools as a doctor without 
books. In order to compete successfully with others it is nec- 
essary to keep pace with the medical literature of the day. 
Then if you do not succeed the best financially, you will have 
the inward consciousness of devoting your entire ability to your 
profession. The lot of a phvsician is a hard one. Pain and 
anguish constantly surround him. He has few hours for rest 
and recreation. His honors and fees are inbrdinately small in 
comparison to the character of work performed. Holmes says: 

'' How blest is he who knows no meaner strife 
Than art's long battle with the foes of life ! 
No doubts assail him, doing still his best, 
And trusting kindly Nature for the rest.'' 

I can give no better words in closing than those of Talmage : 
*' Encourage all physicians. You thank him when he brings 



346 UPS AND DOWNS OF THE PRACTITIONER. 

you up out of an awful crisis of disease; but do you also 
thank nim for treating the incipient stages of disease so skill- 
fully that you do not sink as far down as an awful crisis? 
There is much cheap and heartless wit about the physician ; 
but get sick, and how quickly you send for him. Some say 
doctors are of more harm than good, and there is a book writ- 
ten, entitled, * Every Man His Own Doctor.' The author ought 
to write one more book and entitle it 'Every Man His Own 
Undertaker.' Do you think physicians are hard-hearted because 
they see so much pain? Ah, no ! The most eminent slirgeon 
of the last generation in New York came into the clinical 
department of the New York Mediod College when there was a 
severe operation to be performed on a little child. The surgeon 
said to the students gathered around him : * Gentlemen, there 
are surgeons here who can do this just as well as I can. You 
will excuse me, therefore, if I retire. I cannot endure the sight 
of suffering as I once could.' There are so many trials, so 
many interruptions, so many exhaustions in a physician's life 
that 1 rejoice that he gets so many encouragements. Before 
him open all circles of society. He is welcomed in cot and 
mansion. Children shout when they see his gig coming, and 
old men, recognizing his step, look up and say, 'Doctor, is that 
you?' He stands between our families and the grave, fighting 
back the disorders that troop up from their encampments by 
the cold river. No one ever hears such hearty thanks as the 
doctor. Under God he makes the blind see, the deaf hear, the 
lame walk. The path of such is strewed with the benedictions 
of those whom they have benefitted. Perhaps there was in our 
house an evil hour of foreboding. We thought all hope was 
gone. The doctor came four times that day. The children put 
aside their toys. We walked on tip-toe, and whispered, and at 
every sound said 'Hush!' How loud the clock ticked! and 
with all our care the banister creaked. The doctor stayed all 
night and concentrated all his skill. At last the restlessness 
of the sufferer subsided into a sweet, calm slumber, and the 
doctor looked around to us and whispered, 'The crisis is 
past.' When propped up with pillows, the sick one sat in the 
easy chair, and through the lattice the soft south wind tried 
hard to blow a rose-leaf into the faded cheek, and we were all 
glad, and each of the children brought a violet or a clover-top 
from the lawn to the lap of the convalescent, and little Bertha 
stood on a high chair with the brush smoothing her mother's 
hair, and it was decided that the restored one might soon ride 
out for a mile or two, our house was bright again. And as we 
helped our medical adviser into the gig we saw not that the 
step was broken or his horse sprung in the knees. For the 
first time in our life we realized what doctors are worth. In 
some of our minds among the tenderest of our memories is 
that of the old family physician." 



IMPERFORATE RECTUM — CHEESEPOISON. 347 

IMPERFORATE RECTUM. 



BY D. E. ROBINSON, M. D., Manistee, Michigan. 



On June 13, 1884, assisted by Dr. Hincks, I made an autopsy 
on the body of a child which died thirty-six hours after birth, 
from what had been diagnosed as imperforate rectum. The 
anuH and sphincter muscles were well developed. The finger 
would pass readily through the sphincters, but not even a small 
bougie could be passed beyond this point. Within the abdo- 
men we found the entire large intestine in an imperfectly 
developed condition and impervious for the greater part of its 
length. It was about the size of a small lead pencil and resem- 
bled white fibrous tissue in appearance. It was also in two 
unequal portions, the shorter of which, about four inches in 
length, was attached to the ileum, while the longer portion, 
being in the normal position of the colon, terminated in the 
rectum, which was also impervious. It is not so very uncom- 
mon to meet with an imperforate rectum or anus, but cases of 
arrest of development in so large a portion of the intestine, is, 
I think, quite rare, and I report this case for its bearing on the 
operation of colotomy for the relief of similar cases. 



GENERAL CORRESPONDENCE. 



TYROTOXICON— CHEESE POISON.* 



At the meeting of the Michigan State Board of Health, July 
14, 1886, Dr. Vaughan presented a report of his investigations 
on poisonous cheese. It is well known that cases' of severe 
illness follow the eating of some cheese. Such instances are of 
frecjuent occurence in the North German countries and in the 
United States. In England thev are less frequently observed ; 
while in France, where much cheese is made and eaten, these 
cases are said to occur very rarely. A few years ago, the reputa- 
tion of a large cheese factory in Northern Ohio was destroyed by 
the ^reat number of cases of alarming illness arising from eat- 
ing its cheese. Dairymen know this cheese as ''sick" cheese. 

Kinds of Cheese that are Poisonous, — A German author says: 
''The numerous kinds of soft cheese, prepared in small fam- 
ilies, or on small farms, are generally the cause of the symp- 
toms; while it is quite exceptional to hear of symptoms aris- 
ing from the use of cheese prepared in large quantities." Some 
two years ago, a family in Alpena, Michigan, was poisoned by 
eating of cottage cheese; but the cheese which poisoned so 
many in this State last year was made at one of the largest 
factories in the State, and by a thoroughly experienced cheese- 

^Abstract of a paper by Professor V. C. Vaughan, M. D., Ph. D. 



348 CHEESE POISON. 

maker. The old foul-smelling cheese, such as Limburger and 
Schweitzer, have never been known to be poisonous. 

Effects of the Cheese. — The symptoms produced by " sick " 
cheese, as reported by German and American physicians, agree 
quite closely and are as follows: Dryness ox the mouth and 
tnroat with a sense of constriction, nausea, vomiting, diarrhoea, 
headache, sometimes double vision, and marked nervous pros- 
tration. In rare instances the sufferer dies from collapse. As 
a rule recovery occurs in a few hours, or at most after a few 
days. The symptoms of cheese-poisoning and those of sau- 
sage, canned-meats and fish poisoning are very similar, though 
death results more frequently from the others mentioned than 
from cheese poisoning. 

Appearance of the Cheesc^^The samples of cheese examined 
had no peculiarities of appearance, ordor or taste, by which it 
could be distinguished from good cheese. It is true that if two 
pieces of cheese — one poisonous and the other wholesome — 
were offered to a dog or a cat, the animal would select the good 
cheese. But this was probably due to an acuteness of the 
sense of smell possessea by the animal and not belonging to 
man. Indeed if a person tasted a cheese knowing that it was 
poisonous, he might detect a sharpness of taste which would 
not ordinarly be noticed. 

Have we any means of recognizing poisonous Cheese. — ^There 
is no certain means aside from a chemical examination, by 
which a poisonous cheese can be distinguished from a whole- 
some one. The most reliable ready method is probably that 
proposed by Dr. Vaughan a year ago and it is as loUows : Press 
a small strip of blue litmus paper (which can be obtained at 
any drug store) against a freshly cut surface of the cheese, if 
the paper is reddend instantly and intensely the cheese may be 
regarded with suspicion. When treated in this way any green 
cheese will redden the litmus paper, but ordinarily the redden- 
ing will be produced slowly and will be slight. If the piece of 
cheese be dry, a small bit should be rubbed up with an equal 
volume of water, and the paper should then be dipped in the 
water. Dr. Vaughan does not regard the above test as free from 
error, but as the most reliable ready means now known. Everv 
groceryman should apply this test to each fresh cheese which 
he cuts. The depth of the reddening of the paper may be 
compared with that produced by cheese which is known to be 
wholesome. 

Effects on the Lower Animals. — Dogs and cats, at least, are 
not affected by eating poisonous cheese. This is probably due 
to the fact that they do not get enough of the poison from the 
amount of cheese which they eat. The pure isolated poison 
in sufficient doses would undoubtedly produce upon the lower 
animals effects similar to those produced on man. 

Nature of the Poison. — Dr. Vaughan has succeeded in isola- 



ting the poison, to which he has given the name tyrotoxicon 
(from two Greek words which mean cheese and poison). It is 
a product of slight putre&ction in the